Postnatal Depression Prevalence and Impact on Mothers

Introduction

Pregnancy and birth are major life events that are largely positive experiences for most women. Nonetheless, a percentage of women experience mental health difficulties during this period. Statistics suggest that, on average, between 10% and 15% of women report having experienced depression, and roughly 16% report experiences of severe anxiety during the postnatal period. Postnatal depression is clinically defined as a significant depressive episode occurring within the first 12 months following childbirth. Mothers facing postnatal depression may experience feelings of nervousness, loneliness, loss of control, and hopelessness during a period when happiness is widely anticipated. These mental health difficulties can have adverse effects on both women and their infants. The main objective of this literature review is to comprehensively discuss the prevalence of postnatal depression among women who have given birth.

Prevalence of Postnatal Depression

Postnatal depression is a form of clinical depression that can adversely affect women following childbirth. It is a common illness among women and represents a significant public health concern owing to its prevalence. According to Dinesh and Raghavan (2018), estimates suggest that 10–15% of women experience postnatal depression. According to the World Health Organization, depressive disorders are the fourth leading cause of disease burden worldwide and were projected to rise to second place by 2020. Despite this, postpartum depression remains one of the least diagnosed medical conditions, owing to a lack of sufficient and extensive research on the subject.

Postnatal depression may initially appear to be a concern solely for adult mental health; however, research confirms that it can have lasting effects for the mother and also brings child psychotherapy into focus, given its impact on the mother–infant relationship and its adverse effects on the infant's cognitive and emotional development. Considering that postnatal depression affects a significant number of women — approximately 75,000 cases per year in the United Kingdom — it is rightly regarded as a major public health problem. At the same time, it is a condition amenable to preventive interventions that can help ensure that a greater number of infants begin life in less emotionally compromised conditions. Postnatal depression is therefore actively targeted by health professionals, and alongside medication, a variety of treatment models is available (Likierman, 2003).

Maternal Depressive Symptoms

High levels of psychiatric ill health — broadly postpartum depression — have traditionally been reported in research studies. However, a number of more recent studies have demonstrated that high anxiety is increasingly more prevalent than depression, both before and after childbirth, in women. These studies also found that high anxiety and depression are more common during pregnancy than in the postpartum period, not only in women but also in men.

A study by Figueiredo and Conde (2011) examined anxiety and depression in both men and women from early pregnancy to three months postpartum. The results indicated that rates of depression were higher than rates of high anxiety only in women during early pregnancy and the postpartum period; this was not observed during the third trimester of pregnancy or at the time of childbirth. The study also found that women experienced higher rates of both depression and high anxiety than men at the time of childbirth, but not three months postpartum. Furthermore, the findings showed that approximately 16% of parents included in the study were significantly depressed and/or anxious during pregnancy — a considerably higher figure compared to approximately 9% at the three-month postpartum mark. The implication is that it is essential to attend to the mental health of both men and women early in pregnancy (Figueiredo and Conde, 2011).

Maternal depression is a recognized risk factor for poorer outcomes in children. Maternal postnatal depression has been shown to have medium to large effects on mother–infant interactions during the first year of life (Mallan et al., 2015). Mothers experiencing depressive symptoms tend to be less responsive to their infant and show impaired performance across a range of caregiving activities. As a result, diminished maternal responsiveness is a likely mediator of the established associations between maternal postnatal depression and poorer child outcomes. Research by Mallan et al. (2015) provides evidence for the suggested link between maternal postnatal depressive symptoms and lower responsiveness in child feeding interactions, suggesting that support offered to mothers experiencing depressive symptomatology in the early postnatal period may enhance responsiveness in the feeding relationship.

Risk Factors Associated with Depression and Anxiety during Pregnancy

A study by Denis, Michaux, and Callahan (2012) aimed to examine depressive and anxious symptoms while investigating the effect of factors such as social support, self-esteem, and coping mechanisms on these symptoms in women hospitalized due to high-risk pregnancies. In the context of high-risk pregnancy, low self-esteem appears to exacerbate anxious and depressive symptoms. Prior research has also demonstrated that the mother–child attachment process can be adversely affected by longer hospitalization. Several factors, however, appear to play a protective role, including perceived social support and coping strategies. Perceived social support — particularly from close family members — appears to reduce stress in hospitalized women. Hospitalized pregnant women may feel a heightened need to be cared for and are sensitive to the quality of their relationships with medical personnel. The study's findings underscore the importance of providing appropriate psychological support to women with high-risk pregnancies in order to prevent depressive illness and any potential adverse effects during the perinatal period.

Moraitou et al. (2011) examined the relationship between positive emotions and postpartum depression. Positive emotions have been associated with the development of coping resources and resilience across various major life events. Childbirth often provokes positive emotions in women, and these emotions may have a restraining effect on the onset of postnatal depressive symptoms. The results of the study indicated a negative correlation between the intensity of positive emotions experienced and postnatal depressive symptomatology. Factors such as level of education, whether the pregnancy was planned, and ecological and partner support were found to significantly relate to the experience of positive emotions. Women who had planned pregnancies experienced a greater intensity of positive emotions both before and after birth compared to those who had unplanned pregnancies. Employed women also experienced considerably more positive emotions during pregnancy than unemployed women or students — suggesting that engagement in professional life, whether in the public or private sector, may contribute to a sense of self-efficacy, general life satisfaction, and the frequent experience of positive emotions (Moraitou et al., 2011).

Garcia-Esteve et al. (2008) highlight that the family caregiver role and premenstrual syndrome are associated factors for postnatal depression. Their study aimed to identify sociodemographic, psychopathological, and obstetric risk factors linked with postnatal depression (PND) and to assess their relative magnitude. There is growing evidence of gender differences in affective pathology, including prevalence, clinical features, response to treatments, and associated factors — findings that underscore the need to study PND-specific risk factors in women. The outcomes of the study suggest that the family caregiver role and premenstrual syndrome are variables independently associated with postnatal depression.

References

Ali, H., Humza, S., & Saeed, S. (2017). Perceptions of insufficient breast milk: A comparison of depressed and non-depressed lactating mothers. Pakistan Armed Forces Medical Journal, 67(2), 226–231.

Denis, A., Michaux, P., & Callahan, S. (2012). Factors implicated in moderating the risk for depression and anxiety in high risk pregnancy. Journal of Reproductive & Infant Psychology, 30(2), 124–134. doi:10.1080/02646838.2012.677020

Dinesh, P., & Raghavan, S. (2018). A comparative study of prevalence of postnatal depression among subjects with normal and cesarean deliveries. International Archives of Integrated Medicine, 5(2), 6–11.

Figueiredo, B., & Conde, A. (2011). Anxiety and depression in women and men from early pregnancy to 3-months postpartum. Archives of Women's Mental Health, 14(3), 247–255. doi:10.1007/s00737-011-0217-3

Garcia-Esteve, L., Navarro, P., Ascaso, C., Torres, A., Aguado, J., Gelabert, E., & Martín-Santos, R. (2008). Family caregiver role and premenstrual syndrome as associated factors for postnatal depression. Archives of Women's Mental Health, 11(3), 193–200. doi:10.1007/s00737-008-0012-y

Kaaya, S., Garcia, M. E., Li, N., Lienert, J., Twayigize, W., Spiegelman, D., & Smith Fawzi, M. C. (2016). Association of maternal depression and infant nutritional status among women living with HIV in Tanzania. Maternal & Child Nutrition, 12(3), 603–613. doi:10.1111/mcn.12154

Likierman, M. (2003). Post-natal depression, the mother's conflict and parent–infant psychotherapy. Journal of Child Psychotherapy, 29(3), 301–315.

McManus, B. M., & Poehlmann, J. (2012). Maternal depression and perceived social support as predictors of cognitive function trajectories during the first 3 years of life for preterm infants in Wisconsin. Child: Care, Health & Development, 38(3), 425–434. doi:10.1111/j.1365-2214.2011.01253.x

Moraitou, M., Galanakis, M., Stalikas, A., & Garivaldis, F. J. (2011). The relation of positive emotions to postpartum depression. Europe's Journal of Psychology, 112–142.

Parker, G., Hegarty, B., Granville-Smith, I., Ho, J., Paterson, A., Gokiert, A., & Hadzi-Pavlovic, D. (2015). Is essential fatty acid status in late pregnancy predictive of post-natal depression? Acta Psychiatrica Scandinavica, 131(2), 148–156. doi:10.1111/acps.12321

Psychological support for mothers can reduce post-natal depression. (2010). Mental Health Practice, 14(2), 4.

Stein, A., Malmberg, L., Sylva, K., Barnes, J., & Leach, P. (2008). The influence of maternal depression, caregiving, and socioeconomic status in the post-natal year on children's language development. Child: Care, Health & Development, 34(5), 603–612. doi:10.1111/j.1365-2214.2008.00837.x

Uguz, F., Akman, C., Sahingoz, M., Kaya, N., & Kucur, R. (2009). One year follow-up of post-partum-onset depression: the role of depressive symptom severity and personality disorders. Journal of Psychosomatic Obstetrics & Gynecology, 30(2), 141–145. doi:10.1080/01674820802545818

Webb, R., & Ayers, S. (2015). Cognitive biases in processing infant emotion by women with depression, anxiety and post-traumatic stress disorder in pregnancy or after birth: A systematic review. Cognition & Emotion, 29(7), 1278–1294. doi:10.1080/02699931.2014.977849