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Understanding postpartum depression

Many mothers do not seek help due to perceived stigma around postpartum depression (photo by Seema Krishnakumar via Flickr)

Officially, what caused the deaths of Winnipeg mother Lisa Gibson and her two children are under review but there is a likely possibility that postpartum depression played a role. 

Despite growing awareness, there is still a stigma around the condition, which affects approximately 13 per cent of mothers in the first 12 weeks after the birth of a baby and about eight per cent of mothers after the first year. 

The Lawrence S. Bloomberg Faculty of Nursing’s Professor Cindy-Lee Dennis, an expert in the field of detecting, treating and preventing postpartum depression, discusses postpartum depression with U of T News.

What are the ranges of postpartum mood disorders?

There are different postpartum mood disorders. Some mothers will experience “baby blues” – a very common, transient condition that often resolves on its own. On the other end of the spectrum is postpartum psychosis, which affects less than one per cent of mothers and often occurs within the first couple of weeks postpartum.  However, it’s a very serious condition that often requires hospitalization due to significant symptoms such as hallucinations. Another mood disorder that may occur after childbirth is postpartum depression where symptoms range in severity from mild to severe.

For mild depressive symptoms, peer support from mothers groups or non-directive counselling from a public health nurse might be beneficial. Mothers with moderate depressive symptoms often require some form of psychotherapy such as interpersonal psychotherapy and cognitive behavioural therapy and antidepressant medication may be prescribed. Mothers with severe depressive symptoms will frequently require antidepressant medication along with an appropriate therapy.

Is the number of children a mother has a risk factor for postpartum depression?

Postpartum depression is not related to the number of children. However, there are some very strong risk factors that women and their family members should be aware of. If the mother has experienced depression independent of childbirth then she is at risk for another depressive episode with the birth of a baby. Depression and high levels of anxiety during the pregnancy are also risk factors for postpartum depression.

There are also a number of psychosocial variables that place a mother at risk to develop this condition. For example, if a mother lacks social support and feels she has no one to talk to she is more likely to develop depression. A poor marital relationship and a number of “life stressors” or high levels of child care stress also place a mother at risk. Based on the evidence around life stressors, research clearly indicates that if a mother is young, low income, single, or an immigrant she is more likely to develop postpartum depression.

If a mother thinks she has postpartum depression, what should she do?

If a mother thinks she may be experiencing depression she can go online and answer the 10 Edinburgh Postnatal Depression Scale questions. If her score is greater than nine, then she may be experiencing postpartum depression and she should speak with her family physician or a public health nurse who will complete a more detailed assessment and discuss available treatment options. These two resources are an excellent way to begin accessing effective treatment.

In your career studying postpartum depression, have there been improvements in the detection of this condition?

Many mothers think that the symptoms they are experiencing are just a normal response to the stress of having a new baby. If that is the case, they often do not recognize that they are experiencing depression and they do not seek help. However, for some mothers they do recognize that something is wrong but they do not seek help for various reasons including the perception of stigma around postpartum depression.

Society has constructed the role of what a “good mother” is and there’s a perception that being a good mother and being depressed or having a mental illness are at odds. Although this is often not the case, some mothers are very reluctant to admit they may be experiencing depression. To increase detection and treatment, we are strongly encouraging health professionals who are in contact with mothers in the postpartum period to be aware of postpartum depression and to administer the Edinburgh Postnatal Depression Scale if they suspect a mother may be experiencing this condition.

What areas of postpartum depression are you currently researching?

I just received CIHR funding to conduct a study to examine the impact of parental depression in the first two years of a child’s life with a focus on understanding how maternal depression, paternal depression, and dual parental depression affects infant development outcomes. We will also study the prevalence, course, and relationship between maternal and paternal depression. The results will assist in developing innovative and effective targeted interventions for parents based on whether the family has one or two parents with postpartum depression and whether the depressed parent is the mother or the father.

International experts have clearly identified parental depression as a major childhood adversity and shown that effective interventions to address this condition are one of the most important public health preventive strategies we can implement to reduce the long-term negative developmental outcomes among children. Our study will inform the development of effective parental depression interventions with the aim of preventing poor child outcomes.

Kendra Hunter is a writer with the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto.