Mumbai: A study conducted by the Brihanmumbai Municipal Corporation (BMC) run LTMG Sion Hospital and published in the latest edition of Asian Journal of Psychiatry, has highlighted that people have low awareness of perinatal depression- a condition that occurs during pregnancy or the first-year after childbirth.
According to doctors, in the last few years, there has been a rise in perinatal depression because of contributing factors including hormonal shifts, increased stress, physical and environmental changes etc.
The Sion Hospital study, done by the psychiatry department, showed a strong majority of the respondents (93%) were unfamiliar with the concept of perinatal depression.
“It is known that anywhere between 13% to 25% of pregnant women experience some form of stress, depression, or anxiety. It is a major depressive disorder with onset during pregnancy or within four weeks after childbirth. Our study was aimed at finding the perceptions of perinatal depression among pregnant mothers admitted to antenatal and postnatal care wards, as well as their accompanying relatives,” said Dr Sagar Karia, assistant professor, psychiatry department, LTMG Sion Hospital, who was part of the study.
A total of 106 participants, including 46 pregnant mothers and 60 relatives accompanying the mothers took part in study.
Dr Karia explained that perinatal depression may present as depression before or after birth, and often yield long-term consequences for the mother’s mental health, mother-child interactions, and child development.
“Roughly, half of the respondents did not believe that women could experience mental health problems during and after delivery (45% and 50% respectively). A majority of the respondents (77%) believed that a mother does not love her baby if she is depressed after the delivery. The sample size is small but the findings are startling,” added Dr Karia.
Speaking about the contributing factors, Dr Avinash Desousa, immediate past president of Bombay Psychiatric Society (BPS), who was part of the study team said the past history of depression, presence of anxiety, lack of a partner, lack of social support, major transitional life events, poverty, substance use, previous abortion(s), unplanned pregnancies, family violence, and history of abuse, are few than the major risk factors for perinatal depression.
He added that lack of support from the husband, poor relationship with the mother-in-law, marital conflict, and the birth of a female baby may also serve as socio-cultural contributors.
Dr Desousa said in the study, they found that respondents almost solely focused on the child when asked why the period after delivery is sensitive or critical to the mother. “For instance, the most common response was that the mother must take care of the child. Additionally, several respondents discussed how the mother would be weak and in pain after delivery, but must recover in order to be capable of taking care of the child. Less frequent were responses relating the critical period after delivery to the mother’s physical health. None of the responses discussed the mother’s mental health,” he said.
The study showed approximately a third (33.1%) of the respondents (54% of pregnant women and 17% of relatives) responded affirmatively when asked if they knew of women who had suffered from depression after pregnancy.
While the study was done in the lower economic class, gynaecologists from private hospitals say both awareness and acceptance is low in upper class too. They have observed a rise in postpartum depression cases but most of the educated class remain in denial.
Dr Sudeshna Ray, gynaecologist and obstetrician, Jaslok Hospital, Peddar Road said the attitude towards antenatal or postnatal signs of depression is both denial and lack of awareness.
“When we talk about a psychiatric reference and counselling, they immediately shy off saying that it’s not needed. Recently, a 26-year-old first-time mother came with complaints of anger outbursts and aggression at 7 months of pregnancy. It took me three consultations to even agree to see a psychiatrist. Written evidence from the psychiatrist with strong advice for counselling finally convinced them to go ahead with the treatment,” she said.
Dr Ameya Purandare, gynaecologist, Bhatia Hospital, Grant Road said that postpartum depression is a reality and is now seen frequently but not recognised by society. “Irrespective of social-economic status, response to pregnancy-related depression is always poor. When informed, most of them are alarmed and don’t know that it exists. Families feel it is part and parcel of the pregnancy process and will get resolved on its own,” he said.
Dr Purandare said pregnancy-related depression is a spectrum ranging from just minimal post-partum blues to psychosis and depression. “It can be treated with positive support from the family along with appropriate counselling and early psychiatric involvement. While there are many factors triggering pregnancy-related depression, a partner’s involvement in the pregnancy and unpreparedness for the process of labour are significant factors associated with it. Women with thyroid disorders are more likely to get postpartum depression,” he said.
Needs immediate attention
Perinatal depression occurs during pregnancy or the first-year after childbirth.
The study had a total of 106 participants including 46 pregnant mothers and 60 relatives accompanying the mothers.
93% of the respondents were unfamiliar with the concept of perinatal depression.
45% to 50% of the respondents did not believe that women could experience mental health problems during and after childbirth.
77% believed that a mother does not love her baby if she is depressed after delivery.
78% felt that perinatal depression gets better on its own, without formal treatment.
6.4% reported being familiar with the concept of perinatal depression, some commonly identified symptoms included uneasiness, sadness, hopelessness, crying, irritability, fatigue, pain, anger, fear, negative thoughts, and a change in appearance.
72.5% of the respondents felt that all new mothers should be screened for depression and other mental health problems after delivery.