Talking about postnatal depression

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.

“Current education seems to consist of a brief mention in antenatal classes,” she says. “But simply mentioning the condition doesn’t seem to work for two reasons. Firstly, many of the women interviewed said that they paid little attention to the warnings because they believed it would never happen to them and secondly, because many women seem unable to recognise depression themselves this type of education is fairly ineffective. This issue was most potently illustrated by a mother who was a professional in the mental health field and was unable to recognise that she was severely depressed. It is therefore crucial for better detection of PND and initiation of intervention that the people in contact with new mothers, in particular their partners, also be educated about the condition.

“In addition, education on the realities of motherhood is vital as it can assist women to feel less stigmatised when they are not coping. Having them realise that motherhood is not always the wonderful, happy experience they expected from day one often enables them to be more willing to share their fears and anxieties with others.”

The results of McCarthy’s research indicate that the key to treating PND is getting women to communicate about what they are experiencing.

“Having the ability to talk to others seems to be crucial for receiving treatment and may also aid recovery,” she says. “Overwhelmingly, women reported that talking with others was beneficial. By sharing experiences with other women, these mothers discovered that a broad range of women experience PND. Discovering their experiences were not unique was one of the keys to recovery.

“This helped bring about a considerable change in both the understanding and perception of PND. Initial perceptions of PND as an extreme disorder were modified and broadened to include both ends of the spectrum from mild to severe depression. This lessened the stigma and normalised the women’s experience.

“I also think that the recent spate of celebrities, such as Brooke Shields and Courtney Cox, who have publicised their experiences, has been very positive in that it has helped women realise that ‘it can happen to anyone’.

“The key really is to get woman talking when they are not coping as it’s only then that the people in contact with them – partners, GPs, and midwives et cetera – can identify PND.”