Postnatal depression is a common mental health disorder occurring among parents of newborn babies. It is usually thought to have its onset within the first 6 weeks postpartum, but research shows that in fathers, PND is more insidious and prolonged, and may manifest any time within the first year, after which its incidence drops sharply.
PND has many risk factors, including relational and social, biological, and environmental. These factors interact to produce a state of altered feelings and emotions which impact parental attitudes, thinking, and actions negatively. Some of these include the presence of depression in the other partner, financial stress, feelings of incompetence, and fatigue.
An important risk factor is the presence of other comorbid psychiatric conditions. This may be most commonly an anxiety disorder or an obsessive-compulsive disorder (OCD).
OCD consists of three components, namely:
- Intrusive repeated negative thoughts or obsessions
- The resulting anxiety
- Compulsive actions that are repeated to get rid of the anxiety
In postpartum life, this may be illustrated by the common scenario of repeated thoughts regarding germ contamination of the baby, leading to anxiety about infection. This, in turn, leads to compulsive actions such as repeated sterilization of the baby’s clothes, diapers, bottles, and every other piece of equipment which may come in contact with the baby directly or indirectly. This is not required to prevent infection, but is repeated in order to deal with the anxiety.
How OCD relates to PND
During the newborn period, most babies require intensive care and patience. The staggering scale of increased demands upon the time and attention of the parents, not to speak of the physical strain involved, is well recognized in most societies, which therefore tend to offer increased support during this time.
Preoccupation with baby care
Parents typically develop anxiety and worry around this life change. In addition, they may be preoccupied with the infant to an extreme degree in the early days of life, virtually ignoring all the other facts and requirements of daily life which earlier made up such a large part of their existence.
These preoccupations may drive out the normal instinct to play, care for oneself, and relax - all of which are important under the normal situations for mental health. This kind of worrying may peak around the time of labor and delivery for most parents.
During the initial period thereafter, mothers continue to engage themselves almost round-the-clock with infant care, spending about 14 hours a day just checking on or tending to the baby’s needs in various ways.
Fathers at this time spend about half this time thinking about or caring for the infant, in contrast. However, during these interactions, both parents think mostly about how perfect the baby is, and feel oneness and the promise of love shared with the baby.
These thoughts help to build an optimistic and cheerful attitude towards baby care, as well as a feeling of being responsible and able to deal with the baby’s needs at this time. They are, therefore, important in helping to foster proper attachment to the infant despite the increased stress, and the dramatic changes in their schedules and activities.
It is also true, however, that parental thoughts at this time also include worries and fears. Most parents unconsciously fear lest something bad happen to the baby, both before and after birth.
These express themselves in relation to worries about feeding the baby, fears about the baby’s crying, and doubts as to whether they are able to do an adequate job as parents. Above all, they may be unduly concerned about the baby’s overall health and happiness. Such fears are magnified if the baby is obviously sick or needs special care.
Many parents also share secret fears that they may harm or hurt the baby, as by dropping the infant or making a serious mistake in baby care. This occurs especially when stressed or tired, reported by 41 percent of depressed mothers.
Normal parents and depressed parents also have these thoughts, but to a lesser extent and far less frequently. They do not need to develop compulsions to deal with their anxiety, which is recognized as unreasonable.
These worries and unwelcome but persistent obsessive thoughts may lead to compulsive behaviors such as repeatedly checking on the baby’s wellbeing, being unduly strict about the feeding regimen, or being hypersensitive as to the right way to lift or carry the baby.
Extreme avoidance of situations that the OCD parent fears may trigger the symptoms is one response which may in turn cause problems for the parents and the family, as well as for visitors and caregivers.
OCD may also hinder proper bonding with the parents in extreme cases.
PND in mothers may manifest in two ways. Some mothers find they are too detached to care for their baby with any degree of heartfelt interaction. They carry out the most engaging tasks without really enjoying it or even wanting to do them.
On the other hand, other depressed mothers find themselves hovering around their newborns without being able to relax. This may cross the line between normal anxiety and depression, or even enter the realm of OCD. It is true that both defective and excessive emotional vigilance regarding their babies can trigger either PND or OCD.
These typical symptoms of OCD are often found to coexist with or foster PND. Fathers are also found to worry about harming their babies deliberately, in a quarter of cases. Such findings make it likely that parents with OCD will develop depression, as a result of accumulated negative effects which diminish their coping skills and resilience.
It is also possible that these factors may multiply each other’s toxic effects, predisposing to postnatal depression and affecting the family detrimentally.
Reviewed by Susha Cheriyedath, MSc