Postpartum Depressive Symptoms: They Don’t Always Just Go Away

Being pregnant and becoming a mother was an overwhelming experience for “Alice.” She had trouble sleeping, felt apathetic, and she was on the verge of crying most of the time. “Elaine” didn’t get much sleep either; she was nervous, constantly worried for her baby, and could start crying over the tiniest things. Hospital staff told both mothers that having the “baby blues” was normal the first few days after birth and that it would soon go away.

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Returning home after discharge, “Alice” suddenly decided to stop breastfeeding and barely managed to provide her baby with practical care such as bottle-feeding and changing diapers and clothes. For “Elaine,” many of her worries disappeared as she learned to know her baby and started to appreciate and enjoy caring for her baby, despite the fact that she didn’t get much sleep at night.

They were both told by their parents, friends, and nurses how lucky they were to have such lovely babies. While “Elaine” agreed and felt a growing sense of competence as a mother, “Alice” didn’t feel lucky and was certainly not very happy – “When are the so-called baby blues supposed to end?” she wondered. “What if it doesn’t go away?”

Symptoms Of Depression May Behave In Different Ways

Stories such as these were the starting point for our study conducted in child-health centers with nurses that were trained in the Edinburgh-method (i.e., screening for perinatal depression and offering counseling, max. 4-6 sessions, to women with a moderate symptom level). We asked the following questions; Are there groups of women with different developmental pathways in depressive symptoms? Who are these different groups of women? Do groups of women that may need help and support receive any supportive counseling?

The study included more than 1,300 women that were followed up with through their baby’s first year of life. The good news was that the level of depressive symptoms was very low for 90% of the women, and their symptoms even decreased over time. These women were the first group we identified and were considered to have a low risk of developing difficulties associated with depressive symptoms.

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The second group of women we identified was the remaining 10%. These women had scores around the cut-off on a depression scale for what can be considered a likely mild-to-moderate depression. This group of women did not get better over time. In fact, they had persistent and elevated depressive symptoms throughout the baby’s first year of life.

These results are in line with previous studies that, despite often finding several different groups of women with depressive symptoms, tend to identify a group of women with elevated, stable, and persistent depressive symptomatology.

Who Are These Women And Do They Get Help?

Considering the impact depression may have on mothers and babies, it becomes important to learn who these women are, to identify them as early as possible, provide counseling to women with moderate symptoms, and refer them to specialists in cases of severe depression. What we found that confirms previous research findings was that these women were more likely to have had a history of previous mental illnesses, exhibit elevated symptoms of depression during pregnancy, and experience complications after birth.

The good news was that the chances of receiving supportive counseling was almost 20 times higher among women at risk for depression as defined by the score on the depression scale. This suggests that it is useful to screen for depressive symptoms for early identification of women at risk and that they are more likely to get help sometime during the first year postpartum, although it is also a question whether they receive help and support as early as they should and if the help is effective.

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However, it also turned out that 42% of the women at risk did not receive any counseling during this period. There may be perfectly good reasons why some of them didn’t receive or declined help and support. Even positive life events, such as moving to a bigger apartment to get that extra bedroom for the baby, getting married, or holding a baptism, are stressful. Some may also already be receiving some form of help and support from family and friends. Nevertheless, it seems unlikely that this applies to as many as 42% of these women. The concern here is that too many vulnerable women did not receive help, which may explain why these women didn’t seem to get any better, at least, as a group.

In conclusion, there are good reasons for child-health centers to identify and offer women help and support for signs of depression. Because depressive symptoms don’t always just go away.

These findings are described in the article entitled Latent trajectory classes of postpartum depressive symptoms: A regional population-based longitudinal study, recently published in the Journal of Affective Disorders.

Reference:

  1. Drozd, F., Haga, S. M., Valla, L., & Slinning, K. (2018). Latent trajectory classes of postpartum depressive symptoms: A regional population-based longitudinal study. Journal of Affective Disorders, 241, 29–36. https://linkinghub.elsevier.com/retrieve/pii/S016503271830973X

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