Postpartum depression: Clinical psychologist talks about symptoms and risk factors

A history of mental health issues, unplanned or unwanted pregnancy, prenatal depression, difficulty breastfeeding, and relationship or financial troubles can put new mothers at risk of postpartum depression, says clinical psychologist Dr. Poojashivam Jaitly. New fathers, with a history of depression, are at risk as well.

In India, as many as 22% women suffer from postpartum depression post child birth, according to a study. Some of the important risk factors in India are: financial difficulties, lack of family support, marital conflict, history of mental health issues, and low maternal education.

In this part of the postpartum depression series, Dr. Jaitly talks about the symptoms, risk factors, the cases of late onset, and more. Edited excerpts: 

Research suggests that women in India spend very little time at the hospital post giving birth, which is a major contributor to the lack of awareness about postpartum depression. Doctors and healthcare workers don’t get to speak to them about it. Is that so?

The lack of awareness is a very significant reason for postpartum depression not being reported and women not getting the kind of help that they need. The awareness has to start before childbirth. Yes, the hospital stay is very short, and the subsequent visits to either to the paediatrician or a gynaecologist are focused more on the baby and the recovery of the mother physiologically, but not mentally. In India, mental health is not taken very seriously, therefore it is only the really severe cases that are reported to our clinics. Although, things are changing slowly and young mothers are becoming more aware, but it isn’t enough still.  Most women are still hesitant to seek help.

Sometimes women may have mild symptoms, but they persist for a long period of time. These women are able to carry on with their life, they think it will pass and they will feel better as the baby grows. these cases don’t get reported either. There’s a lack of awareness, people don’t know about it, and there is a stigma attached to seeking help for mental health conditions, making it harder for women to report it.

Tell us about the symptoms?

The important symptoms are — feeling depressed or having severe mood swings, excessive crying, difficulty bonding with the baby, withdrawal from family, inability to sleep or disturbed sleep, reduced interest in pleasurable activities, and irritability or outbursts of anger. Women may also feel extreme anxiety, hopelessness, worthlessness, helplessness, panic attacks, recurring thoughts of how their life has changed or feeling that life is not worth it. In severe cases, women may also have thoughts of harming themselves because they just can’t deal with it.

Are women with a history of mental health issues more prone to postpartum depression? Tell us about the risk factors?

Absolutely, yes. It is one of the big risk factors. If someone already has a mental health condition or has had one in the past, if they’ve had depression or if they have felt depressive or anxious states, prior to their pregnancy, they are likely to experience postpartum depression. Young mothers are more susceptible as well. It also depends on the kind of support system and the care the mother receives. All these have an impact on the presentation and the prognosis of the condition. The other risk factors include — relationship or financial troubles, difficulty in breastfeeding, an unplanned or an unwanted pregnancy, prenatal depression, or depression during pregnancy. Women with a history of abuse, or those who have a baby with special needs are at risk as well. 

What about the cases of late onset?

It is very important to understand that women can actually experience it much later. While a large number of cases appear right after birth, or within the first four to six weeks, as women undergo intense hormonal changes. But there are women who may experience the symptoms even a year to 18 months post delivery. And it can last for a long period of time, sometimes even for a year. It is also often misdiagnosed, misunderstood, or  not even understood at all. It often happens when their partners go back to work or the care they were receiving early on after birth, diminishes, and they start to feel overwhelmed. Delayed symptoms can be because of lack of sleep, increased stress, exhaustion, feeling unattractive or not being able to lose the “baby weight” etc.

A lot of times women suffer in silence from delayed postpartum depression. Sometimes, new mothers start to realise the changes that have happened in their life because of childbirth much later, and they find it very difficult to manage them. Now, we also have a significant population of young mothers who are working and the demands on them are manifold. They find it difficult to carry on, and juggle their work and the baby. This can be an added factor for postpartum depression. In fact, some of them decide to take a backseat in their career, this can push them into a ‘fight’ state and make them experience symptoms of postpartum depression more intensely.

What about fathers, can they experience postpartum depression?

Yes. Some new fathers can experience postpartum depression because they may feel sad, fatigued, or overwhelmed. They may feel they are missing their partner, their sleeping pattern is not the same. Men with a history of mental health issues like depression are more prone to it. This can negatively affect the mother and the child’s development, if the father is unable to cope with it. Again, it depends on the kind of support system they have, the kind of circumstances they are living in, how well are they able to cope with the demands placed on them, and how much of help and guidance is available to them to carry on with the challenges that parenting brings with it.

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