Post-natal depression and anxiety (or non-psychotic depression)

Post-natal depression and anxiety (or non-psychotic depression) Symptoms constituting illness must be distinguished from
‘normal’ reactions to the multiple physiological, psychological and social
stresses accompanying the arrival of a baby. A new mother is almost inevitably exhausted, preoccupied with and concerned about herself and the baby, and may
be overwhelmed at times with worries about the infant or the marital
relationship while coming to terms with the adjustments entailed in becoming a
mother. Nevertheless, chronic stress and sleep deprivation are a health hazard,
and a diagnosis of clinically significant depression should be considered when
the mood changes or persistent anxiety are of more than two weeks’ duration
and result in physical, psychological and/or significant social dysfunction.
Conservatively estimated, anxiety/depression is suffered by some 15 per cent of
new mothers and, since it frequently goes unrecognised and untreated, can
become a chronic problem (O’Hara, 1997).
Most women who suffer significant perinatal mental illness have a
combination of general risk factors contributing to their vulnerability. These
factors include:
• past history of psychiatric disorder, especially depression (including post-natal
depression) and psychosis, or a significant family history of psychiatric illness.
These factors may indicate a genetic or constitutional vulnerability.
• lack of personal and/or social support, in particular, an unsupportive or absent
partner but also limited social supports, for example, refugee or immigrant
families.
• current stressful life events, trauma or adversity including any complications for
mother or infant such as premature or post-mature delivery, current or recent
bereavement, multiple birth; premature or sick baby; and ‘abnormal’
appearance of baby.
• personality factors, in particular, obsessionality or difficulties maintaining
relationships and limited sense of self, for example, in people with Borderline
Personality traits.
• previous or early trauma including a history of physical, emotional or sexual
abuse or problematic relationships with family of origin. Some studies also
suggest previous obstetric or gynaecological difficulties.
Some studies also indicate that maternal age (<18 or >32 years) and marked
ambivalence about the pregnancy are also contributing risk factors (O’Hara,
1997).
Women who fail to attend for ante-natal care or who are identified during
pregnancy as suffering significant anxiety or depression are at risk of increased
difficulties after delivery. As mentioned above, women who have no partner or
support person in attendance, suffer severe ‘blues’ or ‘pinks’ (‘highs’) or experience breastfeeding problems also need careful monitoring in relation to
their mental health and well-being.