Ongoing media and community campaigns have helped to destigmatise, and inform about, a wide range of mental illnesses. However new Macquarie University research into postnatal depression has revealed that the identification and uptake of treatment for this disorder remains a serious problem among sufferers.
Postnatal depression affects about 10 to 20 per cent of women giving birth in Australia. Left untreated, the impact on the mother, her child and other family members can be profound. Once only spoken about in hushed tones, US actor Brooke Shields’ recent very public battle with the illness and subsequent dialogue with Tom Cruise over her choice to undergo drug treatment thrust the condition into the spotlight due to the intense media attention it received.
Dr Michelle McCarthy, whose doctoral research investigated the acceptance and experience of treatment for postnatal depression (PND), says this media attention, alongside recent Australian advertising campaigns which aimed to destigmatise mental disorders, are positive steps towards making depression and other disorders more acceptable.
However, in spite of these initiatives, McCarthy is quick to point out that a number of barriers to treatment still exist among women who experience symptoms of PND, and worryingly, the majority of the women in McCarthy’s study only sought and received treatment after they had reached “crisis point”.
“It was surprising that depressive symptoms had become so severe before the women sought treatment, that most of them had reached crisis point – which for some meant they felt they could no longer look after their baby or no longer wanted their baby, while for others it meant they had become suicidal and required hospitalisation,” she says.
“It had been assumed at the outset of the study that women would make a conscious decision about seeking and accepting help. However, it was clear that for the most part they did not go through a measured decision-making process, nor did they feel in control. Although the women realised something was wrong, they were unable to distinguish between normal levels of distress and distress which warrants help. For many mothers the initiation of contact with mental health services was organised for them by a midwife, GP or relative.”
McCarthy suggests that it may be because of the very characteristics of depression – negative thinking, irritability, hopelessness, disturbed appetite, lack of self esteem, lack of concentration, decreased motivation, feelings of inadequacy, suicidal thoughts and reduced capability to make decisions – that a woman’s ability to recognise or acknowledge PND and to act on that recognition by initiating contact with health professionals is seriously diminished.
A second barrier to seeking treatment, explains McCarthy, was linked to the stigma associated with the inability to cope as a new mother.
“The effect of this stigma meant that women did not disclose their distress to others and it may be that unrealistic expectations about motherhood create a barrier to disclosure,” she says.
“While some spoke to their partners, this self-imposed isolation from friends, including other mothers, meant women had less opportunity to differentiate their own level of distress from what is considered ‘normal’ and this may have exacerbated their depression as well as contributed to the delay in seeking help. Women therefore need to be encouraged to challenge their views of what constitutes a ‘good mother’ and take a broader perspective which includes individuality and time out for oneself.”
The women involved in McCarthy’s study were all diagnosed and treated for postnatal depression in the Community Mental Health Service. In addition to medication, the treatment they received involved weekly home visits by a mental health nurse which consisted of education about postnatal depression, strategies to manage anxiety and low mood, supportive counselling, implementing home help, and liaising with the partner and other family members.
It is this kind of education, which isn’t currently offered as standard to new mothers, that McCarthy believes is essential in overcoming PND.