When speaking of mental health issues faced by mothers, the first that comes to mind, almost immediately, is postpartum depression. According to Dr. Helen Chen, head of KK Women’s and Children’s Hospital’s (KKH) Department of Psychological Medicine, “depression affects 6 to 8 percent of postnatal women in Singapore”. So while it is only right we continue to talk about postpartum depression and its effect on mothers, we need to be mindful that there is more to maternal mental health than that.
Because the awareness of postpartum depression is higher, though not sufficiently high enough, the public may see maternal mental health as the term in its broken-down form – “postpartum” and “depression”. Postpartum is defined as the time after a woman has given birth and depression, a type of mental health disorder. Plainly put, the public is aware that women are at risk of depression after they give birth.
But what about the women who are still pregnant? And what about other mental health disorders that both mothers and mothers-to-be are susceptible to?
1.Depression in pregnant women are more common and often overlooked
News of pregnancy is usually coupled with joy and excitement. However, as with every new stage of life, pregnancy comes with a list of things to adjust to – a changing body, mood swings, and a new set of “rules” to follow. This transition can be overwhelming and may result in an increased risk of depression during pregnancy, also known as prenatal or antenatal depression.
According to Dr. Cornelia Chee, Director of the Women’s Emotional Health Service at National University Hospital (NUH), she “estimates the prevalence of prenatal depression in Singapore at about 12 percent”. This statistic is higher than the 7 percent of women that have been diagnosed with postpartum depression.
However, because some symptoms of depression such as low mood, irritability, and poor sleep, look very much like the hallmark of being pregnant, the symptoms experienced by this group of women may be disregarded by the people around her and sometimes, by the mother herself.
Even if pregnant mothers do recognize that their symptoms are because of antenatal depression, the stigma around mental health may prevent them from reaching out and receiving treatment. As Dr. Chee shared in this article, “there is still a stigma attached to seeing the psychiatrist. It is not acceptable in society to seek help for a mental problem.” And this might be especially so when pregnancy is seen as a time of joy and celebration. Not one that is rife with deep-seated negativity. Dr. Chee adds that NUH has screened more than 9,000 pregnant women from 2008-2011 and about a third of these women were at risk of antenatal depression. However, “in a sign of how unacceptable depression is, only two-thirds – or about 2,200 – agreed to return for further assessment.
Why is this important to remember?
KKH has found that antenatal depression can be a predictor of postpartum depression and increases the risk of mothers being depressed after giving birth. Dr. Helen Chen adds that about 50% of women who were depressed while pregnant also go on to be depressed postpartum.
Identifying these women as early on in the pregnancy as possible may help lessen the impact of depression, should it occur further along her motherhood journey. With professional help, these women will be taught to identify warning signs, equipped with coping strategies, and informed of various avenues they can reach out to for support. In some cases, nipping it in the bud also means a faster recovery. A study conducted by KKH has shown that about 80% of patients diagnosed with antenatal depression recovered within 8 months with the appropriate intervention.
Furthermore, understanding and expressing that pregnancy can also be a difficult time for a mother as it is joyous, helps assure these women that there is nothing wrong with seeking professional help. This is especially important for mothers who are aware but hesitant to seek treatment because of the social stigma attached to seeking help for mental health disorders, let alone when with child.
2.There is more to maternal mental health than just postpartum depression
Mental health issues occur on a wide spectrum. Mood disorders during and after pregnancy range from the baby blues to more severe disorders such as postpartum psychosis. And just as mental health occurs on a spectrum, the symptoms characteristic of each mood disorder vary as well. With depression, you have some of the better-known, but not limited to, symptoms such as persistent sadness and crying. On the other hand, symptoms of postpartum anxiety may manifest itself in a mother constantly worrying about the health and safety of her newborn child to the point it impairs her daily functioning.
Mothers can also be diagnosed with, or a combination of, anxiety, Obsessive Compulsive Disorder (OCD), Bipolar Disorder, or Post-Traumatic Stress Disorder (PTSD).
Why is this important to remember?
Many people often mistake persistent sadness to be the only indicator of an impending mental health issue. Because of this, other symptoms are often overlooked or go unnoticed. In some cases, such as with postpartum anxiety, symptoms can even be labelled as “normal”. As Ms. Katherine Stone, founder of the blog Postpartum Progress, shared
“The term postpartum depression can sometimes do “a disservice” to those women who struggle after having a baby, but don’t reach out for help because they think sadness is the only hallmark of a mental health problem.”
It is important we remember that symptoms of mental health disorders are not limited to sadness. Educating ourselves about the variety of symptoms help identify mothers who are in need of support, especially when the mother herself is unable to recognize what she may be struggling with or is afraid of seeking help.
We extend our heartiest congratulations to pregnant mothers and remind them to take good care of their physical bodies. However, we also ought to remember that these very mothers may also be experiencing an overwhelming amount of mental strain. A mother’s mental health is as important, if not more important, and should be given the attention and support it needs right from the very start of her motherhood journey – pregnancy. And before we can do so, we need to understand that there is more to maternal mental health than just postpartum depression. We need to understand that there is a multitude of mood disorders that mothers and mothers-to-be are susceptible to and a spectrum of symptoms apart from sadness that we need to look out for.