What is postpartum depression?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), postpartum depression is a form of major depression that begins within a few weeks after delivery. Diagnosis of PPD is mostly based on the severity of the depression, not only on the length of time between delivery and onset of the condition.
What are the symptoms to look out for?
It is important to state that how often postpartum depression symptoms occur, how long they last, and how intense they feel can be different for each person. The symptoms of postpartum depression are similar to symptoms for depression, but may also include crying more often than usual for no reason, feelings of anger and crankiness, withdrawing from loved ones, feeling numb or disconnected from your baby, worrying that you will hurt the baby, feeling guilty about not being a good mom or doubting your ability to care for the baby, loss of pleasure, feelings of worthlessness, hopelessness, and helplessness, thoughts of death or suicide, thoughts of hurting someone else, trouble concentrating or making decisions, among others.
To be diagnosed with PPD, symptoms must begin within three to four weeks following delivery. An important qualification is that the pattern of behavioural or psychological symptoms must cause significant personal distress, impair the ability to function in one or more important areas of life, and represent a serious departure from the prevailing social and cultural norms.
What causes PPD?
Scientists do not know exactly what causes postpartum depression, but genetic factors may play a role, and environmental factors may also contribute. Some of the factors that have been associated with PPD include a history of mental health problems, particularly depression, earlier in life, a history of mental health problems during pregnancy, having no close family or friends for social support, a poor relationship with your partner, recent stressful life events, such as bereavement, and experiencing the “baby blues”.
Are there early risk factors of the condition?
Yes, findings from the meta-analyses studies had showed that depression during pregnancy, anxiety during pregnancy, experiencing stressful life events during pregnancy or the early puerperium, low levels of social support and having a previous history of depression, high levels of childcare stress, low self-esteem, neuroticism etc., were the early risk factors of PPD.
How does this condition present itself in women of different ages?
It is important to note that the literature pertains to adult women of 18 years and older. Study by Troutman and Cutrona (1990), which examined the rates of postpartum depression in mothers aged 14 to 18 years (n=128) showed a much higher rate of illness, approximately 26 per cent. However, within this younger population there may be risk factors which predispose not only to postpartum depression, but also to pregnancy during adolescence and therefore are not independent risk factors for postpartum depression. It has long been established that PPD usually begins within one to 12 months after delivery. In some women, “postpartum blues” simply continue and become more severe. In others, a period of wellbeing after delivery is followed by a gradual onset of depression.
Research findings has shown that PPD is characterised by tearfulness, despondency, emotional instability, feelings of guilt, loss of appetite, and sleep disturbances as well as feelings of being inadequate and unable to cope with the infant, poor concentration and memory, fatigue and irritability. Some women may worry excessively about the baby’s health or feeding habits and see themselves as ‘bad’, inadequate, or unloving mothers.
Recent studies by womensmentalhealth.org reveal that younger women are more at risk of slipping into the condition. How true is this assertion?
This may be so because teenage pregnancy comes with some form of stigma in some cultures which may predispose the younger women who give birth to postpartum depression. And again, younger women may slip into postpartum depression owing to the fact that they were not prepared for childbirth and the fear that they may not meet up with their mates after delivery.
Are there any preventive measures against this condition?
Yes. Some of the preventive measures are but not limited to psycho-education, which should be part of antenatal and postnatal classes; social support from partner, friends, family members, etc., physical activity and/or exercise, cognitive behavioural therapy and others.
What differentiates PPD from post-traumatic stress disorders?
What differentiates postpartum depression PPD from post-traumatic stress disorder is the fact that PPD occurs mainly after childbirth while PTSD is a mental health condition that is triggered by a terrifying or traumatic event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. Also PPD is a form of mood disorder whereas PTSD is a form of anxiety disorder.
Is postpartum anxiety a mental health disorder?
They are two different things which most researchers mix up. One is anxiety, whereas the other is depression. So, it is not true; it is not listed in DSM-5 and ICD-11.
The Edinburgh postpartum depression scale is the most used method of handling the condition. How effective is it in Nigeria?
The Edinburgh postpartum depression scale has been validated, used and proven to be effective among Nigerian women.
Many Nigerians don’t believe depression is an issue of concern. Why do you think this is?
The answer is simply because most Nigerians lack awareness about mental health and available mental health services.
Can this condition lead to suicide?
Depending on the severity, depressed patients who are untreated are more vulnerable to suicidal thoughts, and suicide.
Is it treatable using medicine or does one have to undergo therapy?
Again, it depends. Psychotherapy is preferable or both.
How often do you advise one to go for therapy?
How often one would go for therapy depends on the severity of the condition.
Does PPD occur after every birth?
No and yes. Some women experience it after their first births and may not have the condition again if well-tackled when it presented itself at first. Some do not have it until their last birth. Also, some may have something trigger the untreated, accumulated ‘molecules’ in their subconscious, and may have slight display of some of the symptoms. So, it is not a one-cap-fits all situation.
Are there women who may never have this condition at all?
Yes. Many researches have proven that most women never experience this condition at all.
What research efforts have been undertaken in this field?
Globally there are a considerable number of research efforts about PPD in the developed societies. But in Africa, and other low and middle income countries, research is grossly inadequate.
James Robson is a clinical psychologist and occupational health and safety expert.
Interview by Godfrey George
@ Punch Newspaper