Understanding and Preventing Perinatal Depression
Pregnancy and childbirth is a significant life event for any women. But it also brings about lots of responsibilities and is associated with a range of emotional reactions during pregnancy and childcare. The period of pregnancy and childbirth most susceptible to these is the Perinatal Period. It starts from 20th to 28th week of gestation (Approximately 5 to 7 Months of pregnancy) and ends 1 to 4 weeks after birth.
During the perinatal period, women are more prone to lots of physical and mental health issues. Physical issues are easily identified and properly managed due to improving maternal health services owing to Governmental participation in India. But somehow, mental health services in India are still lagging behind and for maternal mental health further inadequate.
The perinatal period is associated with a variety of emotional changes but all of them don't tantamount to psychiatric disorders although they may increase the risk of disorders later in life. Just like are Postpartum Blues (baby blues) i.e. temporary symptoms of mood swings, crying spells, anxiety and difficulty sleeping? Baby blues typically begin within the first two to three days after childbirth and may last for up to two weeks. It usually resolves spontaneously. Women are at high risk of developing many psychiatric disorders like perinatal depression, perinatal anxiety, perinatal OCD, postpartum psychosis and postpartum PTSD.
Perinatal depression is one of the most common Psychiatric disorder of the perinatal period; Prevalence of antenatal depression can be as high as 20%, while approximately 12% to 16% of women experience postpartum depression. Prevalence of postpartum depression is 100‒150 per 1000 births in India. Since the cases of maternal depression are underreported, underdiagnosed and undertreated these estimates are conservative. While baby blues are mild and transient, perinatal depression is more severe and is associated with significant dysfunction in nearly all spheres of life including childcare. Symptoms of dysphoria, emotional lability, insomnia, confusion, anxiety, guilt, and suicidal ideation are present along with low self-esteem, inability to cope, feelings of incompetence, and loneliness. Despite being significantly deteriorating, it is poorly recognizes because firstly motherhood is expected to be a joyful experience and so they fear that they will be considered bad mothers and, secondly they fail to understand their own symptoms and so assume them to be due to exhaustion and adjustment difficulties in their new role, thirdly stigma of being identified as mentally ill person.
Research studies have consistently shown that the risk factors for perinatal depression include stressful recent life events, poor social support, a previous history of depression, childcare stress, low self-esteem, maternal neuroticism, difficult infant temperament, obstetric and pregnancy complications, negative cognitive attributions, single marital status, poor relationship with partner, and lower socioeconomic status and low income.
It is important to note that the etiologically it has both biological (genetic, neurobiological and environmental) and psychological factors and their interactions as causation. And so it is not just stress or poor coping. The condition needs adequate management since it has a long-lasting negative impact on the mother as well as a child since it can be managed effectively with psychotherapies or pharmacotherapy or a combination of both.
Since perinatal depression has both short term and long term negative impact on the mother as well as the child, strategies to prevent it must be implemented. First of all, all women coming to antenatal care should be assessed for risk of developing perinatal depression. Those, particularly at high and moderate risk, should be referred to Psychiatric/ psychologist for interventions in the form of cognitive behavioural therapy and interpersonal therapy which are found to reduce the incidence of perinatal depression significantly. Psychoeducational interventions are also effective in reducing the incidences of postpartum depression along with postnatal support and strategies to reduce perinatal stress and improve mental wellbeing.