Written by:

Dr Sylvia Garry

BA, BMBCh, MRCPCH, DTMH

Dr Garry is a public health doctor currently training in London. She previously trained in paediatrics and has a particular interest in the mental health of parents in the perinatal period. She has worked in North London, looking at improving services that support families during this time period. She is especially interested in improving the health of populations and has just completed her MSc in Public Health.

Postnatal Depression

In this article:

  • Symptoms
  • Who is at risk?
  • Why is this a problem?
  • What can be done to reduce postnatal depression?
  • What help is available?
  • Main points
  • References

Postnatal Depression

The physical, hormonal and chemical changes of pregnancy and post-pregnancy make women especially vulnerable to mental health difficulties.1 Problems are common from the point of conception until a year after birth. Around 1 in 5 women are affected by mental health difficulties in the year following pregnancy, and most commonly 1-2 months after birth. There is a strong association of postnatal depression with problems in the antenatal period, with an overlap in symptoms and risk factors.

Symptoms

Mental health difficulties can manifest themselves in many ways during this time. Depression is common and causes women to experience low mood, a loss of interest in the world around them, tiredness, a lack of energy and diminished enjoyment in life. Women affected may have difficulties in sleeping or doing daily tasks, or may experience feelings of self-harm. Symptoms can also be manifest by developing unhealthy relationships with food, drugs or alcohol. Symptoms of anxiety can exist alongside depression, with repetitive, intrusive and unwanted thoughts.

Who is at risk?

Specific factors increase the risk of postnatal depression.2 A previous episode of depression or other mental illness, or a family history of mental illness can predispose women to developing postnatal depression.3 Women most likely to have difficulties during this time period are those who feel isolated from their partners or families, who are unemployed or homeless, or who have many young children at home already.4 Women with complications during pregnancy or who have lost their babies are also especially vulnerable.

However mental health problems can also occur for women without these risk factors. And it isn’t just women who are affected by postnatal depression; their partners are also at risk. An estimated 1 in 25 men experience depression in the perinatal period, which is likely to be an underestimation.

Why is this a problem?

The challenge with mental health is the range of severity with which these symptoms present. At the extreme end, women are severely affected by depression and require intensive inpatient support to prevent harm from occurring. At the other end of the spectrum, a large number of women are affected by depression but are able to hide the difficulties they experience from people around them. They may seem to be coping with everyday life events. However, early intervention can have a huge positive impact on their lives and as such early identification of problems is vital to help build resilience and prevent further problems from occurring.

Mental health difficulties do not just impact the parent, they also have a wide-reaching effect on relationships with partners and on their children. Maternal anxiety and depression are linked to behaviour and emotional problems in the children of families affected. 144,000 babies under 1 year in the UK live with a parent who has a mental health problem.5 Maternal depression or anxiety are linked to lower IQ in their children at 11 and 16 years of age; increased violence behaviour at 11 and 16 years; and increased risk of depression at age 16.6

What can be done to reduce postnatal depression?

We know that isolation is a big risk factor for postnatal depression, and that building strong relationships can help protect women from mental health difficulties. This includes relationships with partners, families, friends and communities. Local groups and charities have emerged in multiple areas of London to provide peer-support and share experiences.

Other lifestyle factors such as eating a healthy balanced diet, drinking plenty of water, and getting regular sleep and exercise can all improve wellbeing and reduce low mood or anxiety. Of course, this is especially challenging as a new baby arrives into the family, which is why communicating feelings of low mood and receiving practical help and support are so important.

What help is available?

The first step to identifying a mental illness is to talk about mental health. Difficulties during this period are common and people affected may feel alone and isolated. Mental health difficulties are often hidden as people find themselves unable or unwilling to admit they are finding everyday life challenging. Mental illness is stigmatised, and tackling this stigma is vital to facilitate people to talk about the problems that they face, understand that these are not a weakness, and that steps can be taken to help them and their families.

Many sources of support are available for women and families. Health visitors, general practitioners and midwives are all involved with looking after the health of women and their families. During and following pregnancy, they will ask women questions around their feelings and mood. These healthcare professionals are often the first port of call, and are ideally placed to provide support and advice. They may signpost families onwards to talking therapies such as IAPT (Improving Access to Psychological Therapies), prescribe medications to help with symptoms, or refer women onwards for one-on-one support or group therapies.

If healthcare professionals identify a more serious problem they will refer the woman onwards for inpatient help. Psychosis, extreme low mood or self-harm require more intensive support7 which may require an inpatient stay in a Mother and Baby Unit. These are ideally situated to care for the requirements of women and their babies. This is challenging time for families. However, most women with postnatal depression are managed in their homes, with ongoing support of healthcare professionals and support networks around them.

Main points

  • Around 1 in 5 women experience mental health difficulties in the year after pregnancy, and most commonly 1-2 months after birth
  • Symptoms range from depression and anxiety to low energy, lack of interest or drug or alcohol abuse.
  • A family history of mental illness increases the likelihood that a woman is predisposed to PND.
  • Homelessness, lack of support and isolation during pregnancy all increase the risk of PND.
  • It is thought that at least 1 in 25 men also experience depression in the perinatal period.
  • One problem with identifying and diagnosing PND is the different ways symptoms present. In some women, it may be obvious, in others problems may only be apparent beneath the surface.
  • Maternal anxiety and depression are associated with behavioural and emotional problems in the children.
  • Eating well, having a healthy lifestyle and having strong and supportive family and community can reduce the impact and incidence of PND.
  • Help is available for women with PND. Midwives and doctors can direct women towards therapies such as IAPT (Improving Access to Psychological Therapies). Sometimes medication may be helpful.
  • Psychosis, extreme low mood or self-harm require more intensive support.

References

  1. Antenatal and postnatal mental health: clinical management and service guidance, NICE guidelines [CG192] Published: Dec 2015
  2. SIGN 127, Management of Perinatal Mood Disorders, March 2012, Scottish Intercollegiate Guidelines Network
  3. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM, ‘Risk factors for depressive symptoms during pregnancy: a systematic review’ Am J Obstet Gynecol. 2010 Jan; 202(1): 5–14.
  4. Howard LM, Oram S, Galley H, Trevillion K, Feder G. Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLOS Medicine. 2013;10(5):e1001452. doi: 10.1371/journal.pmed.1001452.
  5. Cuthbert C, Rayns, Stanley K, All Babies Count, Prevention and protection for vulnerable babies. NSPCC 2011
  6. Hogg S, “Prevention in Mind All Babies Count: Spotlight on Perinatal Mental Health”, NSPCC, 2013
  7. Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2015.