tag:theconversation.com,2011:/fr/topics/postnatal-depression-17758/articlesPostnatal depression – The Conversation2023-09-21T20:06:51Ztag:theconversation.com,2011:article/2074282023-09-21T20:06:51Z2023-09-21T20:06:51ZFriday essay: my father was always told his mother was dead, but a birthday card revealed she was living in a mental institution<figure><img src="https://images.theconversation.com/files/548947/original/file-20230919-15-7z704n.png?ixlib=rb-1.1.0&rect=17%2C5%2C3976%2C1988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ada, the author's grandmother, is pictured at right.</span> </figcaption></figure><p>As a child, I found a small, brown suitcase in my wardrobe. It had two silver latches and a squeaky wooden handle. I didn’t recognise the name inscribed on the bottom in pencil: <em>Ada</em>. </p>
<p>I asked my mother, “Whose suitcase is this?” Mum replied, “Your grandmother’s.” </p>
<p>I was confused about who my grandmother was. Born in the early sixties, I grew up with my parents and two older brothers in Melbourne’s eastern suburbs. Dad had grown up without his mother and was cared for by his paternal grandmother. </p>
<p>It was around the time of my birth when Dad accidentally discovered the secret of his mother’s whereabouts. Ada was living in a mental institution. </p>
<p>As a young child, I remember waiting with my family for Ada in the foyer of a boarding house in Melbourne. This memory is like a single snapshot of a dimly lit, wood-panelled foyer, marked by the tension of my two brothers being scolded for their noisy behaviour as we waited for Ada to join us for a family outing. </p>
<p>Another time, I recall Ada sitting in the lounge room of our family home, smoking cigarettes. I tried to engage her, but she would not smile, and her face and eyes lacked expression. I knew there had been something wrong with Ada. I am uncertain when I learned she had been removed from her children and locked away. </p>
<p>As my father grew to know her more, stories of her absence from his childhood emerged. It was impossible for me as a child to understand Dad was getting to know his mother for the first time as an adult: a parent with his own children. </p>
<p>For a long time, I had the sense Ada had problems related to her menstrual cycle and that once a month, her periods threw her off balance, and she was placed in the sick ward of the mental hospital for one week out of every month.</p>
<p>The notion that being female caused her sickness gave me some foreboding as a young girl. But of course, that wasn’t true: it was just one example of the lies we were told about what had happened to her.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548952/original/file-20230919-19-z1l47p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/548952/original/file-20230919-19-z1l47p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548952/original/file-20230919-19-z1l47p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548952/original/file-20230919-19-z1l47p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548952/original/file-20230919-19-z1l47p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548952/original/file-20230919-19-z1l47p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548952/original/file-20230919-19-z1l47p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548952/original/file-20230919-19-z1l47p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ada (far right) with her daughter-in-law and two grandsons, after being reconnected with family.</span>
</figcaption>
</figure>
<h2>A hidden mother, revealed</h2>
<p>Dad had been raised from a baby by his paternal grandmother (a widow), who he knew as Gran. His older sister, Hannah, was placed, aged four, into a Melbourne boarding school for girls, Lowther Hall in Essendon. Dad’s father, who lived elsewhere in the same town, visited the children on Sundays at Gran’s.</p>
<p>The children were reunited when Hannah returned to Gran’s care, aged eight, when Lowther Hall was requisitioned for American military requirements in 1942. Dad grew up assuming his mother was no longer alive.</p>
<p>Dad married my mother in his early twenties. Together, they lived with Dad’s father, who I called Pop. Soon after, Dad and Mum built a new home in the outer suburbs of Melbourne and notified the local post office about their change of address. Dad received a birthday card redirected from his former address. It was signed <em>Mother</em>. </p>
<p>He thought it must have been a mistake. Dad drove to his father’s house, determined to get to the bottom of the situation. He waited a few hours, his mind swirling, before Pop returned home. Finally, he questioned Pop about the card. </p>
<p>Pop admitted it was a genuine birthday card from Dad’s mother: Ada had been living in a mental institution all this time. Pop then produced a bundle of letters and cards Ada had written to her children over more than 20 years. Pop was instrumental in keeping Ada a secret from her children. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548967/original/file-20230919-23-ikags5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/548967/original/file-20230919-23-ikags5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548967/original/file-20230919-23-ikags5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548967/original/file-20230919-23-ikags5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548967/original/file-20230919-23-ikags5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548967/original/file-20230919-23-ikags5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548967/original/file-20230919-23-ikags5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548967/original/file-20230919-23-ikags5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ada had written to her children for over 20 years, with her letters kept a secret from them.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/pile-of-letters-in-envelopes-1768060/">Suzy Hazelwood/Pexels</a></span>
</figcaption>
</figure>
<p>Now, the secret was out: Ada was alive and living in a Melbourne mental hospital. It is difficult to understand why Pop had kept Ada’s letters all this time without saying anything. One can only guess he had intercepted and confiscated Ada’s letters to her children to protect them from the shame and stigma of mental illness. </p>
<p>It seems likely Pop intended to continue Ada’s long estrangement, had that birthday card not slipped into Dad’s hands that day. </p>
<p>Over 20 years of letters and cards, and not one reply. Ada never forgot her children. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-a-lament-for-the-lost-art-of-letter-writing-a-radical-art-form-reflecting-the-full-catastrophe-of-life-197420">Friday essay: a lament for the lost art of letter-writing – a radical art form reflecting 'the full catastrophe of life'</a>
</strong>
</em>
</p>
<hr>
<h2>The first of many visits</h2>
<p>Soon after finding that fateful card, Dad contacted the mental hospital – and met his mother for the first time he could remember. He recalled his first meeting with Ada in the early 1960s at <a href="https://www.findingrecords.dhhs.vic.gov.au/CollectionResultsPage/Mont-Park-Hospital-Macleod">Mont Park mental hospital</a> in Bundoora, Melbourne. He waited to meet Ada in a small walled garden and was told she would not be much longer. </p>
<blockquote>
<p>I was nervous and unsure of what she would look like and what to say to her. I waited for 20 long minutes, and my anxiety increased. When she opened the door, there she was. But six people followed her to take a look at her son. I didn’t know whether to give her a kiss or give her a hug. The first thing she said to me was: “You look just like your father.” They were the last words I wanted to hear at that moment.</p>
</blockquote>
<p>As Pop had hidden his mother from him, Ada’s comment had a painful sting. This was the first of many visits together. Dad recalled taking us to collect Ada from Carmel House, where I remembered waiting in the foyer for her. We took her on outings and occasional weekends to our family home. He recalled:</p>
<blockquote>
<p>When we went to pick her up from Carmel House, she was always late and I remember waiting in that timber-panelled foyer, looking searchingly at the stairs, until she made her entrance. When I was working in the city, Mum used to go and get her hair done on her days off, and we would meet afterwards at the Town Hall corner, and go off to Coles Cafeteria, her favourite eating place. But then she would go into the toilets and wash her hair out, so sometimes when I met her, she looked a bit wild and woolly, like she had been diving in the Yarra River. She certainly had her eccentricities.</p>
</blockquote>
<p>As Dad and Ada got to know each other and tentatively forged their new relationship, it was still unclear why Ada was committed to a mental institution in the first place. </p>
<p>Dad and his older sister Hannah had little contact or knowledge of Ada’s family of origin. They were surrounded by the silence of his mother’s whereabouts throughout their upbringing, until Ada’s card arrived for him in his twenties. </p>
<h2>‘I felt closer to Ada’</h2>
<p>Dad and I wanted to understand the events that precipitated her committal. We found we could access Ada’s mental-patient files by applying for a Freedom of Information request. We discussed it together, and Dad agreed as Ada’s next-of-kin. I purchased Ada’s birth and wedding certificates, to make sure I requested the correct person’s files. </p>
<p>I found out Ada was the younger sister of five brothers. She married in 1934 at 21 years old, and her occupation was stated on her marriage certificate as a “comptometer operator”. A <a href="https://www.pcmag.com/encyclopedia/term/comptometer">comptometer</a> is a key-driven mechanical calculator, which was operated predominantly by women, and her occupation suggests Ada had completed a specialised business course. Advances in office technology in the early 1930s gave many young and unmarried women like Ada new opportunities for employment in clerical positions. </p>
<p>However, most industries excluded married women, and it’s likely Ada left her job when she married my grandfather in 1934, and moved to the country.</p>
<p>Three months after making the request, we received Ada’s mental-patient files, which ranged from her original committal in 1936 to her death in 1972. Ada’s records include the committal certificates, diagnoses, notes on trial leave, experimental treatments, and her final years as an outpatient at Carmel House. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/548954/original/file-20230919-27-ww4vm9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/548954/original/file-20230919-27-ww4vm9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/548954/original/file-20230919-27-ww4vm9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=684&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548954/original/file-20230919-27-ww4vm9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=684&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548954/original/file-20230919-27-ww4vm9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=684&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548954/original/file-20230919-27-ww4vm9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=860&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548954/original/file-20230919-27-ww4vm9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=860&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548954/original/file-20230919-27-ww4vm9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=860&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ada’s photo from her medical files.</span>
</figcaption>
</figure>
<p>As I opened the files for the first time, Ada’s headshot appeared on the first page of her first admission certificate in 1936. Her shoulders are angled and her gaze is focused to the right of the camera’s lens.</p>
<p>At age 24, Ada is youthful and smiling. She wears a dress with a large, white collar, possibly the same clothes she wore when she left home. I was shocked to see our similar physical appearance. I could see my face in hers: the same high forehead, small eyes, fair skin and wavy hair. I felt closer to Ada. </p>
<p>Ada’s patient files show her mental health began to deteriorate following the birth of her second child. She experienced auditory hallucinations when committed to the Royal Park Receiving House in Melbourne in 1936, two weeks after giving birth. The doctor described her as lucid, with “nervous symptoms that alternate between depression and exaltation along with auditory hallucinations”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/girl-interrupted-interrogates-how-women-are-mad-when-they-refuse-to-conform-30-years-on-this-memoir-is-still-important-199211">Girl, Interrupted interrogates how women are 'mad' when they refuse to conform – 30 years on, this memoir is still important</a>
</strong>
</em>
</p>
<hr>
<h2>‘Puerperal insanity’ – associated with giving birth</h2>
<p>The cause of her attack is noted as “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8953002/pdf/atlantajrecmed141958-0005.pdf">puerperal insanity</a>”, which psychiatrists associated with Ada giving birth two weeks before. </p>
<p>Hilary Marland, in her book <a href="https://link.springer.com/book/10.1057/9780230511866">Dangerous Motherhood</a>, argues puerperal insanity is a 19th-century diagnosis that links insanity to recent childbirth – and links lactation, pregnancy and miscarriage to mental illness. Marland found that in the 19th century, puerperal insanity accounted for approximately 10% of admissions in English asylums. </p>
<p>I found a similar rate of birth-related committals had occurred in Victoria in the early 20th century, in my PhD thesis <a href="https://researchportal.scu.edu.au/esploro/outputs/doctoral/Maternal-insanity-in-Victoria-Australia/991012821132602368">Maternal Insanity in Victoria, Australia 1920-1973</a>. </p>
<p>Alexander Wallis’ article <a href="https://press-files.anu.edu.au/downloads/press/n7444/pdf/08_wallis.pdf">Unnatural Womanhood</a> suggests puerperal insanity, in today’s terms, is understood as <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/postnatal-depression-pnd">postnatal depression</a>.</p>
<p>Four days following Ada’s first admission, her doctor recorded his observations:</p>
<blockquote>
<p>The patient is cheerful and talkative. She says that lately, she has had numerous auditory and visual hallucinations. She is quite disorientated as regards time and place. Her answers to questions are quite irrelevant and she smiles and talks cheerfully most of the time.</p>
</blockquote>
<p>I researched the history of “puerperal insanity” and its association with dangerous mothers and infanticide. A dark and taboo subject, it conjures the “madwoman” trope in our cultural imagination and is rooted in popular discourses of the murderous mother, the crazy wife in the attic, or the suicidal mother. </p>
<p>The horror of maternal insanity plays on our worst fears: as vulnerable young babies, we depend on our mothers to care for us.</p>
<p>It’s upsetting that an outdated 19th-century diagnosis was still being used to commit mothers like Ada in 1936. In the 100 years that had passed since “puerperal insanity” was coined, psychiatry had still not developed a better understanding of motherhood, or mental illness.</p>
<p>Within the first two months of her committal, the doctor described Ada as “restless, apathetic, and erratic in behaviour”. The timing of giving birth and the changes in Ada’s behaviour led to the diagnosis of “puerperal insanity” and her committal in 1936.</p>
<p>Yet her files lack information on the length of her labour, delivery method and the health of the mother or the newborn child. Unfortunately, Ada had given birth at a time in Victoria when mothers faced severe health risks during childbirth, due to <a href="https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/ajo.13317">poor standards in obstetrics</a>.</p>
<p>A difficult or protracted delivery may have contributed to Ada’s deteriorating mental health, but the details of birth events are rarely included in a mother’s mental files. Despite the lack of information on Ada’s birth experience, her psychiatrists continued to tie childbirth with maternal insanity, as they had in the past.</p>
<p>Nine months after her original committal, Ada went home on trial leave. By March 1938, she was fully discharged as recovered. Ada spent the next two years at home with her family. Then, she became pregnant with her third child. </p>
<p>Unfortunately, Ada’s behaviour became erratic during pregnancy. With consent from her husband, she underwent a “therapeutic abortion” and sterilisation. </p>
<p>I found these procedures a disturbing part of Ada’s files. Her history of puerperal insanity likely provided the psychiatric grounds to proceed, but it did not bring her peace of mind. </p>
<p>In May 1940, soon after the therapeutic abortion and sterilisation, Ada was re-committed back into a mental institution, this time to Mont Park Hospital for the Insane in Melbourne – where she was when Dad found her in the early 1960s.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548956/original/file-20230919-21-v4agzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/548956/original/file-20230919-21-v4agzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548956/original/file-20230919-21-v4agzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=455&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548956/original/file-20230919-21-v4agzu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=455&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548956/original/file-20230919-21-v4agzu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=455&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548956/original/file-20230919-21-v4agzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=572&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548956/original/file-20230919-21-v4agzu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=572&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548956/original/file-20230919-21-v4agzu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=572&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mont Park Hospital (circa 1920), where Ada was when her son found her in the early 1960s.</span>
<span class="attribution"><span class="source">State Library Victoria</span></span>
</figcaption>
</figure>
<h2>‘A world divorced from reality’</h2>
<p>Ada underwent a series of <a href="https://www.britannica.com/science/insulin-shock-therapy">insulin-coma treatments</a> (ICT) for the next three months. ICT involves giving patients daily injections of insulin to induce hypoglycemia and coma. <a href="https://www.britannica.com/biography/Manfred-J-Sakel">Manfred Sakel</a> developed ICT in Europe and at Mont Park the therapy was implemented by Dr Farran-Ridge and Dr Reynolds. </p>
<p>Under the supervision of Dr Reynolds, Ada showed “marked improvement” following ICT every morning for three months:</p>
<blockquote>
<p>Mentally much improved – states she is no longer hallucinatory although remembers that she was so and seemed to have gained full insight into her condition. A satisfactory remission.</p>
</blockquote>
<p>ICT appeared to aid Ada’s recovery by ending her auditory hallucinations for the first time, but these effects did not last. It proved a dangerous and experimental treatment when <a href="https://www.webmd.com/schizophrenia/features/insulin-coma-therapy">some patients died</a> due to complications. Ada experienced a short-lived remission and again returned home for six months of trial leave. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548959/original/file-20230919-17-13lt4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/548959/original/file-20230919-17-13lt4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548959/original/file-20230919-17-13lt4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548959/original/file-20230919-17-13lt4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548959/original/file-20230919-17-13lt4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548959/original/file-20230919-17-13lt4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=527&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548959/original/file-20230919-17-13lt4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=527&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548959/original/file-20230919-17-13lt4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=527&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ada was treated with insulin coma therapy. ICT treatments are pictured being performed in Stockholm in the 1930s.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Insulin_shock_therapy">Wikipedia</a></span>
</figcaption>
</figure>
<p>Upon her return to the institution, Ada suffered grandiose delusions. It is hard not to believe going home on trial leave, considered helpful in some instances, contributed to Ada’s worsening mental health. Her doctor described her delusions of grandeur in January 1942:</p>
<blockquote>
<p>She claims she arranged the introductions between Duke & Duchess of Kent. She is willing to oblige for a fee of 1000 pounds to do same for the royal personages. She stated this country is now known as L’Aurolia Republic – it was Australia prior to the revolution in 1900. She says she is a member of Russian Royal family and her real name is Lily Vertel Rose Alvaradora Icebel and says herself “Alvara Russia”.<br></p>
<p>She has numerous other fantastic and bizarre delusions. Naturally she is somewhat exalted. She admits hearing voices talking about British Secret Service work so cannot divulge subjects discussed. She is cheerful and cooperative, her mood is cheerful, but she is living in a world divorced from reality.</p>
</blockquote>
<p>Dad and I marvelled at Ada’s audacity, intellect, and creativity in her grandiose delusions as a Russian princess and British spy. We wondered if our royal status had gone awry. </p>
<p>Further examples of her grandiose delusions are evident in two letters Ada wrote and held within her files. The first letter is Ada’s application to join the <a href="https://www.awm.gov.au/learn/understanding-military-structure/ran/wrans">Women’s Royal Australian Naval Services</a> in 1943. It is her response to a recruitment drive that sought women to help with increased naval demands. She offered her medical services as a trained doctor and surgeon, fabricated her educational credentials and persisted in her claim of royal birth. </p>
<p>The hospital surveilled all patient letters and prevented Ada’s application from being sent. The address she provided for correspondence was the Female Ward, Mont Park Mental Hospital, which indicates Ada had some grasp on her present reality. </p>
<p>Like the other thousand women who enlisted with the Women’s Royal Australian Naval Services by the end of 1942, Ada wanted to help in war service and gain employment.</p>
<p>The second letter in her files, written in 1943, is addressed to her husband. It reads in part:</p>
<blockquote>
<p>One of the patients here has been friendly and helps to pass the time. With your consent, we are planning to go to England together as I must see to my English affairs, being of Russian titled birth. I inherited from my father about twenty-six years ago, various properties in England, America and Australia, also Europe, these properties, and affairs await my attention in London. Also my Army Commission, with the British Secret Service, which commission continues from my last visit to London.<br></p>
<p>And lastly, my enormous will, I must change it to include yourself, my husband, and only two children, and those several titles to descend upon both, also a ducal title upon yourself from marriage (to me), now Alva.</p>
</blockquote>
<p>Ada certainly did not see herself as any ordinary mental patient. Instead, her grandiose delusions illustrate her desire for social mobility and increased status – by casting herself as a wealthy Russian royal working as a British spy. Such grand ideas likely provided Ada with a sense of purpose, power and optimism. </p>
<p>In Victoria Shepherd’s book, <a href="https://www.simonandschuster.com/books/A-History-of-Delusions/Victoria-Shepherd/9780861545308">A History of Delusions: The Glass King, a Substitute Husband, and a Walking Corpse</a>, the author argues delusions are a far preferable alternative to the dramatic loss of status that occurs when a life goes catastrophically wrong. Delusions serve to reconcile a fallen and lowly existence. </p>
<p>We can see this in Ada’s grand delusions: acting as royalty and a highly educated spy gave her ambitions direction and a sense of purpose, as a patriotic Australian and loyal subject to the British Crown and the Commonwealth during wartime. The Women’s Royal Australian Naval Services application attests to this. Shepherd also reminds us that by listening very closely, we can gain a deeper understanding of people experiencing delusions. </p>
<p>I hear Ada’s demand for dignity and respect as her response to the injustice she suffered – and to the loss of her autonomy, power, freedom and the ability to mother her two children. Unfortunately for Ada, displaying her grand delusions meant no further trial leave, following her return to Mont Park in 1943. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-black-bile-malaria-therapy-and-insulin-comas-a-brief-history-of-mental-illness-206580">Friday essay: 'black bile', malaria therapy and insulin comas – a brief history of mental illness</a>
</strong>
</em>
</p>
<hr>
<h2>A schizophrenia diagnosis</h2>
<p>Ada spent the next 20 years in several mental institutions in Victoria without trial leave, which was often a pathway to discharge for patients with supportive families. Her files are brief throughout the rest of the 1940s and mid-1950s, following Ada’s grandiose delusion letters. </p>
<p>In 1948, her doctor noted Ada was “considerably improved, is much quieter, works in the wards and is no trouble in any way”. A further entry states she is a “delusional schizophrenic whose moods are variable”. </p>
<p>This is the first time “schizophrenic” has been used in Ada’s files. By 1954, Ada is transferred from B ward to A ward. She: </p>
<blockquote>
<p>works daily in B ward, which she calls going to the office. Some delusions. Wishes to go home and finish her studies at the university. </p>
</blockquote>
<p>The mention of her ward work as “going to the office” shows her sense of humour and is a reminder of the days she worked in an office, as a comptometer operator, before her marriage. </p>
<p>And her desire to complete university points to her desire for social mobility through educational aspirations.</p>
<h2>Domestic service</h2>
<p>In the 1950s, Ada worked as a domestic servant for Dr Donnan and his family, when he was a medical officer at Mont Park mental hospital. After one year, Dr. Donnan was promoted to Chief Superintendent Psychiatrist at Beechworth Mental Hospital in regional Victoria, and the family took Ada with them. </p>
<p>Sally, Dr. Donnan’s youngest daughter, recalls travelling with her family and Ada from Melbourne to Beechworth for her father’s new position:</p>
<blockquote>
<p>There were five of us, including my elder sister, driving up to Beechworth in Dad’s Alvis vintage car with lots of luggage. It got dark and none of us were that comfortable being in the middle of the bush at night. The car conked out at a river crossing, water was running over the road, in the dark. Ada was sitting between us two kids in the back, gripping our hands. Anyway we got going again, though I don’t remember the rest of the trip.</p>
</blockquote>
<p>Ada lived in the Donnan’s family home located within the grounds of the mental hospital and continued to work as their domestic servant. The Beechworth Mental Asylum was built in 1867, and by the 1970s it was renamed <a href="https://tour.maydayhills.org.au">Mayday Hills Psychiatric Hospital</a>. It still stands today. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548742/original/file-20230918-15-yknd4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/548742/original/file-20230918-15-yknd4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548742/original/file-20230918-15-yknd4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=362&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548742/original/file-20230918-15-yknd4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=362&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548742/original/file-20230918-15-yknd4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=362&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548742/original/file-20230918-15-yknd4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=455&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548742/original/file-20230918-15-yknd4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=455&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548742/original/file-20230918-15-yknd4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=455&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Asylum, Beechworth, circa 1920s.</span>
<span class="attribution"><span class="source">Courtesy of the Bourke Museum, Beechworth Victoria</span></span>
</figcaption>
</figure>
<p>Sally recalls Ada and her mother working together in their home:</p>
<blockquote>
<p>Everything was on time, the routine, brushing hair, cleaning shoes, preparing school uniforms and meals. I seem to remember Ada being dressed very neatly every day, usually in a black skirt and white shirt. She wore her hair in a well-cut bob. I always remember her wearing thick beige stockings and stout black shoes. Pink complexion, blue eyes. She never wore makeup.</p>
</blockquote>
<p>By 1963, Dr. Donnan transferred to Brierly Mental Hospital in Warrnambool, Victoria, but this time the Donnan family could not take Ada with them. </p>
<p>Ada transferred back to Mont Park in Melbourne, and in the doctor’s transfer request, he wrote:</p>
<blockquote>
<p>She spent all her time working for Dr Donnan. She worked quite satisfactorily and seemed very happy with Dr Donnan and his family. After Dr Donnan left the hospital she is missing the family very much and would like to return to Mont Park.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548958/original/file-20230919-25-itb0rx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/548958/original/file-20230919-25-itb0rx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548958/original/file-20230919-25-itb0rx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548958/original/file-20230919-25-itb0rx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548958/original/file-20230919-25-itb0rx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548958/original/file-20230919-25-itb0rx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548958/original/file-20230919-25-itb0rx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548958/original/file-20230919-25-itb0rx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Donnan residence, where Ada lived and worked as a domestic servant at the Beechworth Mental Asylum.</span>
</figcaption>
</figure>
<h2>Late days</h2>
<p>It was around this time Dad first met Ada, anxiously waiting for her in that walled garden at Mont Park. In 1964, a year and a half later, Ada moved to Carmel House, a residential boarding house for female patients in Preston, Melbourne. From there, she continued to work as a domestic servant and regularly met my father for lunch at Coles cafeteria in the city. </p>
<p>By this time Ada’s condition was described as a “chronic schizophrenic, with auditory hallucinations, and has delusions that she is related to royalty”.</p>
<p>The antipsychotic drugs <a href="https://www.webmd.com/drugs/2/drug-6572/stelazine-oral/details">Stelazine</a> and <a href="https://www.webmd.com/drugs/2/drug-6901/mellaril-oral/details">Mellaril</a> were prescribed for the first time. Ada’s grandiose beliefs persisted well into the 1960s, as my father recalls:</p>
<blockquote>
<p>The first time Mum stayed at our place for the weekend, she turned to me and
said “Tell me, do you still use your title?” “Er, what title’s that, Mum?” I asked, surprised. “Lord …” she replied, as if everyone knew. “No Mum. People don’t use their titles much these days.” “What a pity,” she said and dropped the matter.</p>
</blockquote>
<p>Ada lived at Carmel House until she died in 1972, aged 60. When I was 11, I accompanied my father there, shortly after Ada’s death. It seemed forever that I waited for him in the car, the sun burning through the glass. </p>
<p>Dad returned and placed that small, brown suitcase, which would later make its way into my childhood bedroom, on the back seat. It was the total of his mother’s personal effects. “Not much for a life,” he said.</p><img src="https://counter.theconversation.com/content/207428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Watts does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Alison Watt’s grandmother was diagnosed with ‘puerperal insanity’ and institutionalised not long after giving birth to her father. He didn’t meet her – or know she was alive – until his early 20s.Alison Watts, Adjunct Lecturer, Faculty of Health, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2073602023-08-29T15:34:41Z2023-08-29T15:34:41ZWhen being a new mum feels overwhelming, here’s some expert advice on what you need to know<figure><img src="https://images.theconversation.com/files/542176/original/file-20230810-11401-f0k38u.jpg?ixlib=rb-1.1.0&rect=11%2C15%2C2544%2C1686&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being a new mother can take a lot of adjustment. </span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/parents-looking-at-their-baby-3584088/">pexels?nappy</a></span></figcaption></figure><p>We are sold the idea that becoming a new mother is the <a href="https://psycnet.apa.org/record/2016-38769-001">happiest time of your life</a>. But for many women, the reality doesn’t fit that perfect picture. Yes, they may love their baby very much but the broader impact of having a baby and becoming a mother can feel far more complex. </p>
<p>Research shows that when we look at happiness over our lifetime, the year after having a baby can be one of our <a href="https://psycnet.apa.org/record/2013-15090-008">lowest points</a>. It’s not about our relationship with our baby but rather the other parts of our lives that have changed so much. Social media hasn’t helped any of this. We are all tempted to just share the best bits, thinking we need to hide our feelings because we think <a href="https://psycnet.apa.org/record/2018-45585-002">everyone else is so happy</a>. But speaking out helps everyone. </p>
<p><a href="https://www.independent.co.uk/news/health/negative-thoughts-new-parents-baby-pregnant-children-parenting-b694300.html">It’s normal</a> to experience some challenging emotions when you become a new parent. You might not immediately bond with your baby, wondering why that flash of love didn’t appear. You might grieve for your old life and identity. You might feel trapped, wanting to escape yet at the same time feeling you can’t leave your baby. </p>
<p>Worries about not being “good enough” for your baby are also common. But honestly, you don’t need to get it right all the time. You are more than enough for your baby. None of these very normal reactions to change mean that you don’t love your baby.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<hr>
<p>But knowing when these are normal feelings and when you might need support is important. At least <a href="https://maternalmentalhealthalliance.org/about/perinatal-mental-health/">one in five</a> new mothers will experience a mental health issue after birth. Though this is likely an underestimation because many hide these feelings. But hiding them just prevents you from getting the support you need. So here are some signs to look out for:</p>
<p><strong>Postnatal depression:</strong> <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postnatal-and-antenatal-depression/">Depression</a> isn’t simply feelings of sadness. In fact, anxiety, about something specific or a general feeling of dread is common. You might lose pleasure in doing things, feel hopeless about the future, or feel very low about yourself. </p>
<p><strong>Anxiety and intrusive thoughts:</strong> We all have moments where we imagine ourselves dropping our baby. Sometimes however these thoughts become <a href="https://www.verywellfamily.com/overcoming-postpartum-ocd-and-intrusive-thoughts-5187982">repetitive, frequent</a> and we can’t make them go away. You might find yourself <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/perinatal-anxiety/">unable to sleep</a> or waking too early. You might feel restless, overwhelmed in public or feel shaky. </p>
<figure class="align-center ">
<img alt="Woman lying in bed with baby." src="https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s normal for life to seem radically altered and to feel a loss of identity.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-resting-on-the-bed-with-her-baby-on-top-6849528/">pexels rdne stock project</a></span>
</figcaption>
</figure>
<p><strong>Postnatal rage:</strong> We often don’t talk about rage when it comes to mothers but it’s <a href="https://www.irishtimes.com/life-and-style/health-family/i-was-a-charging-brutal-half-animal-the-ugly-truth-about-postnatal-rage-1.2950662">more common</a> that you think. You might find yourself feeling on edge or irritable and then snap when something small goes wrong. Hormonal fluctuations and a lack of sleep might exacerbate this but more often it’s a reaction to feeling overwhelmed, powerless and unsupported. </p>
<p><strong>Birth or breastfeeding trauma:</strong> Many women have some difficult memories of birth but sometimes, even if you are able to talk them over with friends afterwards, <a href="https://www.youtube.com/watch?v=A43qlYkSMyU">these don’t go away</a>. You might find yourself having flashbacks, feel unable to go near the hospital or anything that reminds you of the birth, or feel very angry about your experience, or blame yourself. </p>
<p>Your sleep or appetite might be affected, or you might feel very jumpy or on edge. Sometimes these feelings are linked to physical events during the birth, but often they’re more about how you felt or were treated.</p>
<p>Increasingly similar feelings of trauma or grief are being recognised around <a href="https://welldoing.org/article/why-breastfeeding-grief-trauma-matter">infant feeding experiences</a>. If you experienced breastfeeding difficulties or had to stop before you were ready, you might be feeling guilt, anger or loss about that, despite your baby thriving. </p>
<h2>Getting support</h2>
<p>If you’re feeling overwhelmed by the emotions you are experiencing or find your sleep, energy or appetite is affected, here are some things to try:</p>
<figure class="align-center ">
<img alt="Woman with baby and laptop." src="https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Don’t suffer in silence, get as much support and help as you can.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/young-working-mother-cuddling-baby-and-using-laptop-at-home-7282818/">Pexels/sarah chai</a></span>
</figcaption>
</figure>
<p><strong>Talk to friends:</strong> Sometimes just sharing how we feel and realising that others feel this way can help us realise we are not alone </p>
<p><strong>Discuss with your health visitor or GP:</strong> They can help you understand how you are feeling and discuss different treatments such as counselling and medication</p>
<p><strong>Contact one of the many organisations that can help:</strong> The <a href="https://maternalmentalhealthalliance.org/resources/mums-and-families/">Maternal Mental Health Alliance</a> has a list of contacts. You can talk through difficult infant feeding experiences with a <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/help-and-support/">breastfeeding charity</a>. Many doulas (a person who can support you through pregnancy, labour and birth) also offer help to explore <a href="https://doula.org.uk">how you are feeling</a> about your birth and caring for your baby. </p>
<p><strong>Focus on looking after yourself, too:</strong> Your diet, activity levels and time outdoors can all affect how you feel. Do not be afraid to ask others for help or to use sources such as childcare to get some time for you to be able to do this. Explain to them how you feel and what you need. </p>
<p><strong>Creativity is good:</strong> The <a href="https://www.maternaljournal.org/">Maternal Journal</a> project holds in-person and online group sessions supporting you to explore how art can help, while also caring for your baby. </p>
<p><strong>Try baby massage:</strong> It can help you to slow down and connect with your baby. And it can help increase <a href="https://pubmed.ncbi.nlm.nih.gov/11246096/">oxytocin levels</a> in you both, calming your system.</p>
<p><strong>Explore some grounding techniques:</strong> <a href="https://www.healthline.com/health/grounding-techniques#physical-techniques">These can help you</a> to manage your anxiety. When you feel symptoms of anxiety, look for things in the environment around you. Try and find five things that are blue. Or five things that are soft. Count them and say them out loud. </p>
<p>Most of all remember that none of these feelings are anything to do with how much you love your baby or how well you care for them. Often mothers experiencing mental health difficulties are highly attuned to their baby’s needs because they are so worried about not getting it right. Your baby will be fine, but it’s important that you are too.</p><img src="https://counter.theconversation.com/content/207360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has received funding from the ESRC, MRC, NIHR, HEFCW, UKRI, Infant feeding charities and Public Health Wales. She is a trustee for First Steps Nutrition Trust.</span></em></p>New motherhood is often portrayed as a time of joy but it can also be filled with fears and complicated feelings. Here’s how you can get help and support.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982752023-06-02T14:45:22Z2023-06-02T14:45:22ZPostnatal depression: what new fathers need to know – and how to ask for help<figure><img src="https://images.theconversation.com/files/529771/original/file-20230602-15-weta8e.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4157%2C2763&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Postnatal depression symptoms are quite similar to depression symptoms.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-unhappy-father-holding-his-baby-1432243013">christinarosepix/ Shutterstock</a></span></figcaption></figure><p>Many people think of postnatal depression as a condition that only affects women. But in reality, postnatal depression affects <a href="https://www.nhs.uk/mental-health/conditions/post-natal-depression/overview/">almost as many men as women</a> – with some research estimating it occurs in up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659987/">10% of fathers</a>.</p>
<p>Yet despite how common postnatal depression may be in men, there still isn’t very much information out there about it. This can make it hard to know if you may have postnatal depression – and how to get help if you do.</p>
<p>Here’s what you need to know.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/he-is-always-there-to-listen-friendships-between-young-men-are-more-than-just-beers-and-banter-200301?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">‘He is always there to listen’: friendships between young men are more than just beers and banter</a></em></p>
<p><em><a href="https://theconversation.com/body-image-issues-affect-close-to-40-of-men-but-many-dont-get-the-support-they-need-179046?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Body image issues affect close to 40% of men – but many don’t get the support they need</a></em></p>
<p><em><a href="https://theconversation.com/anxiety-can-lead-to-erection-problems-in-young-men-but-reaching-for-viagra-isnt-always-the-solution-191980?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Anxiety can lead to erection problems in young men – but reaching for Viagra isn’t always the solution</a></em></p>
<hr>
<h2>Why it happens</h2>
<p>There are many reasons why postnatal depression happens. And, contrary to popular belief, it isn’t just due to hormones. Even in women, hormones only <a href="https://www.nature.com/articles/nrdp201822">play a small role</a> in postnatal depression.</p>
<p>Instead, postnatal depression is typically due to a <a href="https://pubmed.ncbi.nlm.nih.gov/29096280/">combination of risk factors</a> – such as a previous history of depression, sleep problems after the baby is born, lack of social support or financial challenges. Postnatal depression can also <a href="https://pubmed.ncbi.nlm.nih.gov/30818245/">happen at any age</a>.</p>
<p>The symptoms of postnatal depression are quite similar to symptoms of depression. As such, <a href="https://bestpractice.bmj.com/topics/en-gb/512">symptoms of postnatal depression</a> may include low mood, lack of motivation, poor sleep, feeling guilty or worthless, poor concentration, changes in appetite or weight, fatigue and thoughts of death or suicide. </p>
<p>The main difference between depression and postnatal depression is that these feelings tend to happen in the postnatal period (typically the first year or so after the baby is born).</p>
<p>It can be normal to struggle with your mental health somewhat after your baby is born. After all, it can be an overwhelming and emotional time, with nearly every aspect of your life changing – from your daily routine, your relationship with your partner, to the amount of sleep you get every night. </p>
<figure class="align-center ">
<img alt="Female doctor speaks with male patient." src="https://images.theconversation.com/files/529772/original/file-20230602-29-y77d67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529772/original/file-20230602-29-y77d67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529772/original/file-20230602-29-y77d67.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529772/original/file-20230602-29-y77d67.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529772/original/file-20230602-29-y77d67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529772/original/file-20230602-29-y77d67.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529772/original/file-20230602-29-y77d67.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Consider speaking with your GP if symptoms have lasted more than a few weeks.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smiling-indian-woman-doctor-talking-consulting-2078659627">fizkes/ Shutterstock</a></span>
</figcaption>
</figure>
<p>But if you’ve been experiencing low mood and lack of motivation for more than a few weeks, and are finding these feelings are making it difficult to engage with your infant, you may want to consider speaking with your GP or a mental health professional. It’s also worth noting that postnatal depression can happen at any time in the first year or two after the baby is born – not just in the early months.</p>
<h2>Getting help</h2>
<p>Postnatal depression is not likely to go away on its own. If you suspect you may be struggling with postnatal depression, it’s important to seek support – not only for your wellbeing, but because postnatal depression can also affect your bond <a href="https://acamh.onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2008.02000.x">with your baby</a>.</p>
<p>First of all, there’s <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2020.599039/full">nothing wrong with needing help</a>, and seeking support – either from loved ones, friends or a doctor – is nothing to be <a href="https://www.magonlinelibrary.com/doi/full/10.12968/bjmh.2018.7.3.130">embarrassed by</a>.It does not <a href="https://www.magonlinelibrary.com/doi/full/10.12968/bjmh.2018.7.3.130">make you weak</a>, nor does experiencing postnatal depression make you a “<a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03947-7">failure</a>”. </p>
<p>While it can be difficult to know how to take the first step in getting support, a good starting point is simply acknowledging that this is a difficult thing to talk about. As simple as this sounds, it may just help you feel less awkward about sharing your experiences when you do speak to someone. It’s also worth remembering that when you do speak to someone, it’s important to say how you really feel – not what you feel you should say. </p>
<p>It’s also <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03947-7">normal if you feel angry</a> about feeling the way you do. Many young men who struggle with their mental health feel angry that they feel this way, or worry that they’ve let their loved ones down or that the system will not listen to them. To deal with that anger, be patient. Try to let the anger go – it may help you feel more at ease opening up about your other emotions.</p>
<p>You may also find it easier to talk about your experiences in certain settings. For example, while some people may find it easier to speak with their GP or in online chat groups, you may find it more comfortable to speak up in a less formal setting – such as while watching sports with friends. You can begin this conversation with something as simple as asking how others are doing, before sharing your own feelings and experiences. Or, if your friends are also parents themselves, you might ask if any of them experienced similar feelings during the postnatal period.</p>
<p>If you’re finding it hard to speak to loved ones, you could also consider using a mental health app. Some people find it easier to use an app to ask questions, find solutions and discuss how they’re feeling. Apps such as <a href="https://thedadpad.co.uk/ask-dadpad/mental-health-new-dads/">DadPad</a> have a number of resources that can help you navigate fatherhood. </p>
<p>Postnatal depression in fathers is real and it does matter. Fortunately, compared to just a few years ago, there’s more awareness and help available than ever before.</p><img src="https://counter.theconversation.com/content/198275/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Mayers does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Postnatal depression is thought to affect up to 10% of fathers.Andrew Mayers, Principal Academic in Psychology, Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1821412022-05-25T01:01:42Z2022-05-25T01:01:42ZSurprise! How men react when becoming a dad isn’t part of the plan<figure><img src="https://images.theconversation.com/files/460488/original/file-20220429-13-qbw5dq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-woman-hands-hiding-pregnancy-test-1195326700">Shutterstock</a></span></figcaption></figure><p>For many dads, having a child is unplanned. What happens next can vary. One man said:</p>
<blockquote>
<p>We broke up and she called me soon after to tell me she was pregnant […] she just asked me if I wanted to be in our baby’s life and I accepted without thinking twice.</p>
</blockquote>
<p>Another said:</p>
<blockquote>
<p>I wanted to have an abortion, since we weren’t ready, but it wasn’t my choice, it was hers […] but the resentment was there for a long time.</p>
</blockquote>
<p>These two comments came from tens of thousands of posts on the social media site Reddit we analysed as part of <a href="https://www.sciencedirect.com/science/article/pii/S2667321522000476?via%3Dihub">our research</a> into men’s experiences of unplanned pregnancy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-studied-100-years-of-australian-fatherhood-heres-how-todays-dads-differ-from-their-grandfathers-166348">We studied 100 years of Australian fatherhood. Here's how today's dads differ from their grandfathers</a>
</strong>
</em>
</p>
<hr>
<h2>Unplanned pregnancies are common</h2>
<p>Having an unplanned child is more common than you might think. In Australia <a href="https://pubmed.ncbi.nlm.nih.gov/26456762/">40% of pregnancies</a> are mis-timed, unexpected or unwanted. That’s an estimate comparable with rates <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30029-9/fulltext">worldwide</a>.</p>
<p>Most research on the impact of unplanned pregnancies focuses on mothers. We wanted to know about the experiences of dads. So we turned to two forums specifically for <a href="https://www.reddit.com/r/daddit/">new</a> and <a href="https://www.reddit.com/r/predaddit/">expecting dads</a> on Reddit.</p>
<p>We “scraped” tens of thousands of posts, spanning a year, then applied an innovative <a href="https://pubmed.ncbi.nlm.nih.gov/30744717/">machine learning</a> technique to group the data into meaningful topics. This allowed us to identify themes in the men’s online discussions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/machine-learning-is-changing-our-culture-try-this-text-altering-tool-to-see-how-159430">Machine learning is changing our culture. Try this text-altering tool to see how</a>
</strong>
</em>
</p>
<hr>
<h2>Here’s what we found</h2>
<p><a href="https://www.sciencedirect.com/science/article/pii/S2667321522000476?via%3Dihub">Our research showed</a> men who reluctantly or unexpectedly became fathers experienced a complex range of emotions and reactions. Many needed support. </p>
<p>The dads in our study posted to Reddit using pseudonyms. So they were free to be honest and raw as they shared their emotions on a topic many consider taboo.</p>
<p>Some were “filled with regret”, “sadness”, “guilt” and hopelessness of a “never-ending, soul-crushing grind”. Some lacked bonds with their infants, one feeling “like the tin man without a heart”.</p>
<p>One man said:</p>
<blockquote>
<p>I keep on having really bad breakdown episodes. There are days when I just sit and cry thinking how miserable my life has become.</p>
</blockquote>
<h2>Unplanned fatherhood and postnatal depression</h2>
<p>Earlier research shows it’s common for dads to have <a href="https://www.sciencedirect.com/science/article/pii/S026661381930213X?casa_token=aFeik2hGNskAAAAA:jD_01eW0wFce3gXn9cpmIQV5prFnISfFZRQ_n6W41w19po1iP5evTq6rbR_h9xIDvbvu7FBL94A">short periods of negative thoughts</a> after their baby is born. Feelings of loss about their previous life are common.</p>
<p>However, persistent negative and intense emotions may indicate depression and anxiety at this time.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461490/original/file-20220505-19-yssztk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Baby in cot with father in background clutching cushion, holding head" src="https://images.theconversation.com/files/461490/original/file-20220505-19-yssztk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461490/original/file-20220505-19-yssztk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461490/original/file-20220505-19-yssztk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461490/original/file-20220505-19-yssztk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461490/original/file-20220505-19-yssztk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461490/original/file-20220505-19-yssztk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461490/original/file-20220505-19-yssztk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Unplanned fatherhood increases a man’s risk of postnatal depression.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-baby-bed-young-father-suffering-1656784711">Shutterstock</a></span>
</figcaption>
</figure>
<p>In fact, unintended fatherhood is linked to an <a href="https://psycnet.apa.org/record/2012-26354-019">increased</a> <a href="https://www.sciencedirect.com/science/article/pii/S0277953608005789?casa_token=cUY_BmkyG1AAAAAA:jnaSyT80P963Q7q9-IZXrzO2Djb2tLCuMptqhwKUFUkmzuS1qeAY3yzpiK6n6fyuGlvmRLW2X6U">risk</a> of a man having postnatal depression.</p>
<p>Paternal depression is, in turn, linked to a higher risk of depression <a href="https://pubmed.ncbi.nlm.nih.gov/20483973/">in their partners</a> and more behavioural problems <a href="https://www.mja.com.au/system/files/issues/195_11_121211/fle10192_fm.pdf">in their children</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dads-get-postnatal-depression-too-55829">Dads get postnatal depression too</a>
</strong>
</em>
</p>
<hr>
<h2>Let’s debunk some myths</h2>
<p>Like earlier research, ours debunks the myth that <a href="https://psycnet.apa.org/record/2020-29612-001">men do not seek help</a> when in need. Men sought and received advice and support from other dads about everything from night feeds and nappies to reassurance that what they were feeling was normal.</p>
<p>Studies show <a href="https://pubmed.ncbi.nlm.nih.gov/21464468/">peer support</a>, often online, can be a foot-in-the-door for men who feel uncomfortable disclosing vulnerability. This is particularly important for a taboo subject such as unwanted parenthood. </p>
<p>In our study, not all men were distressed. Some reported feeling happy “but freaking out” and simultaneously “scared, hopeful, excited, terrified”.</p>
<p>Sharing experiences allowed these fathers to validate and normalise the full spectrum of their emotions and sometimes re-frame a sense of hopelessness. </p>
<p>Men told each other “you are not alone”, “I felt the same”, “it does get better” and “it’s not as bad as people say”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/childrens-well-being-goes-hand-in-hand-with-their-dads-mental-health-102347">Children’s well-being goes hand in hand with their dads’ mental health</a>
</strong>
</em>
</p>
<hr>
<h2>How to reduce the stigma</h2>
<p>In this study and <a href="https://journals.sagepub.com/doi/full/10.1177/0265407519864444">our earlier research</a> men said they were concerned that not wanting children would be seen as abnormal.</p>
<p>We hope our work raises awareness that desire for children is not universal. We can do more to normalise and destigmatise varied narratives that represent how people feel about parenthood. </p>
<p>When it comes to family planning, a first step is to include men in discussions about reproductive health before they become fathers and are expecting a child. </p>
<p><a href="https://static1.squarespace.com/static/56e1ed8d3c44d863de3040ee/t/6271c31d5e3a870ef25d1df1/1651622690479/MT2021-09-071-MACDONALD.pdf">Pre-conception planning</a> with health professionals involves becoming physically and psychologically ready for parenthood and is important for mothers, fathers and, ultimately, their offspring. </p>
<p>Once the baby is born, it is important dads have access to support. Family and health-care systems are mainly focused on mothers and infants, and could be better <a href="https://www.healthymale.org.au/resources-tools/current-research-projects-studies/plus-paternal/case-for-change">equipped, resourced and trained</a> to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0165032720330111">detect fathers at risk of mental health problems</a>. <a href="https://coastfraseridpscd.ca/wp-content/uploads/2015/07/Zero-to-3-May-2015-Issue.pdf#page=62">Father-inclusive practice</a> is beneficial to fathers, mothers and children.</p>
<h2>When things go right</h2>
<p>When fathers have access to the right help at the right time, it can make all the difference. One man said:</p>
<blockquote>
<p>I ended up going to a psychiatrist after a suicide attempt. It did some good, it faced me with my own immaturity. May I suggest trying it? Everybody is different, but it seriously helped in my case.</p>
</blockquote>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/182141/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqui Macdonald is convener of the Australian Fatherhood Research Consortium.</span></em></p><p class="fine-print"><em><span>Imogene Smith does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most research on the impact of unplanned pregnancies focuses on mothers. So we turned to Reddit to find out what dads really thought.Imogene Smith, Casual academic, provisional psychologist and Doctor of Psychology (Clinical) candidate, Deakin UniversityJacqui Macdonald, Senior lecturer and research fellow in psychology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1702782021-11-11T03:10:17Z2021-11-11T03:10:17ZPostnatal psychosis is rare, but symptoms can be brushed aside as ‘normal’ for a new mum<figure><img src="https://images.theconversation.com/files/431408/original/file-20211111-5078-qdsz8v.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhappy-woman-suffering-postpartum-depression-sad-1925974949">Shutterstock</a></span></figcaption></figure><p>The period after birth of a child is supposed to be a time of great happiness for women. However, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491613/pdf/WPS-19-313.pdf">a significant number</a> of new mothers will experience a mental illness at this time.</p>
<p>One is <a href="https://www.thewomens.org.au/health-information/pregnancy-and-birth/mental-health-pregnancy/post-partum-psychosis">postnatal psychosis</a> (also known as postpartum or <a href="https://www.cope.org.au/health-professionals/health-professionals-3/perinatal-mental-health-disorders/puerperal-psychosis/">puerperal psychosis</a>). It’s not related to postnatal depression.</p>
<p>Postnatal psychosis affects <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009991.pub2/full">one to two in every 1,000 new mothers</a>, or about 600 women each year in Australia.</p>
<p>But our <a href="https://www.sciencedirect.com/science/article/pii/S026661382100245X">interviews with women</a> who have been diagnosed with this rare but serious condition show their symptoms were often dismissed as a normal part of adjusting to motherhood.</p>
<h2>What is postnatal psychosis?</h2>
<p>Postnatal psychosis affects women across all cultures and geographic areas.</p>
<p>The condition can put a woman at risk of self-harm or suicide and, on rare occasions, of harming others including her new baby or other children.</p>
<p>We don’t know what causes it. But contributing factors may include sleep deprivation, and rapid hormone changes associated with pregnancy and childbirth.</p>
<p>The risk of postnatal psychosis increases if a woman has a history of <a href="https://www.sane.org/information-stories/facts-and-guides/bipolar-disorder#what-is-bipolar-disorder">bipolar disorder</a> or has had postnatal psychosis before.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/JUFRZ6PgfQE?wmode=transparent&start=81" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">One woman tells her story.</span></figcaption>
</figure>
<h2>What are the symptoms?</h2>
<p><a href="https://www.cope.org.au/wp-content/uploads/2017/11/Postpartum-Psychosis_Health-Prof-Fact-Sheet.pdf">Symptoms</a> can begin in the first few days after giving birth but may not appear until up to 12 weeks afterwards.</p>
<p><strong>Some women have manic symptoms</strong></p>
<ul>
<li><p>manic symptoms include feeling they do not need to sleep, and are powerful and strong</p></li>
<li><p>women may have unusual experiences, such as seeing or hearing things others cannot. They may believe things that are not true </p></li>
<li><p>they can also make unrealistic and impulsive plans, can be disorganised or forgetful, and talk very quickly</p></li>
<li><p>their moods may change rapidly or they may seem excessively happy.</p></li>
</ul>
<p><strong>Others have depressive symptoms</strong></p>
<ul>
<li><p>depressive symptoms include a loss of energy and an inability to sleep or eat </p></li>
<li><p>women may have thoughts or auditory hallucinations that they are a bad mother and they may say they wish to die. Hallucinations or delusions (false beliefs) point to postnatal psychosis rather than to postnatal depression</p></li>
<li><p>women may find it difficult to complete activities, such as caring for themselves or their baby, or attending to other tasks in the home</p></li>
<li><p>they may believe they are helpless, hopeless and worthless, especially as a mother </p></li>
<li><p>they can become isolated and no longer enjoy activities.</p></li>
</ul>
<h2>Women say it’s traumatic</h2>
<p>Women say postnatal psychosis is traumatic, especially if they do not get help when they first report symptoms. But it can be challenging to diagnose because of the stigma surrounding mental illness around the time of giving birth.</p>
<p>Women say they are <a href="https://link.springer.com/content/pdf/10.1007%2Fs00737-015-0548-6.pdf">reluctant to disclose</a> unusual symptoms as they feel ashamed they are finding motherhood difficult and worry they may lose custody of their baby.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1457172143737741319"}"></div></p>
<p>When we <a href="https://www.sciencedirect.com/science/article/pii/S026661382100245X">interviewed ten women</a>, who had experienced an episode of postnatal psychosis in the past ten years, we discovered another barrier to diagnosis. </p>
<p>Women said they knew they had unusual symptoms, such as not being able to sleep or changes in the way they thought or behaved, but they found it difficult to get help. Often, they were told these symptoms were a normal part of adjusting to motherhood. </p>
<p>Their postnatal psychosis was not identified until their only option was admission to an acute mental health unit and separation from their baby.</p>
<p>So we need more education about the condition for health-care workers. By identifying the condition earlier, this gives women more treatment options.</p>
<h2>There are treatments</h2>
<p>Once diagnosed, the condition can be treated with antipsychotic and mood stabilising medication, prescribed by a psychiatrist or other treating doctor.</p>
<p>This is <a href="https://link.springer.com/article/10.1007/s00737-009-0117-y">very effective</a> but medication is often not started until the symptoms have become very severe and the woman requires hospitalisation in an acute mental health unit, without her baby. This separation can compromise the developing bond between them.</p>
<p>So early diagnosis can potentially reduce the time a woman may spend in an acute mental health unit.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/postpartum-psychosis-as-we-work-to-find-causes-mothers-still-arent-getting-the-support-they-need-118283">Postpartum psychosis: as we work to find causes, mothers still aren't getting the support they need</a>
</strong>
</em>
</p>
<hr>
<h2>Admission to a mother-baby unit</h2>
<p>Best practice is to admit women and their babies to a <a href="https://www.cope.org.au/wp-content/uploads/2018/05/COPE-Perinatal-MH-Guideline_Final-2018.pdf">mother-baby unit</a>, which is usually linked to a hospital. This allows women to continue to care for their babies with the support of child and family health-care professionals. </p>
<p>However, publicly funded units are only available in Victoria, South Australia, Western Australia and Queensland. In New South Wales, two public mother-baby units <a href="https://www.smh.com.au/national/nsw/new-unit-provides-mother-and-baby-mental-health-support-to-western-sydney-20210909-p58q9v.html">are being built</a>. In NSW, the only existing one is a <a href="https://www.sjog.org.au/our-locations/st-john-of-god-burwood-hospital/our-services/mental-health-and-therapy/mother-and-baby-unit">private facility</a>, which many families cannot afford.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/historical-hospital-records-can-show-us-what-not-to-do-in-helping-psychosis-patients-46012">Historical hospital records can show us what not to do in helping psychosis patients</a>
</strong>
</em>
</p>
<hr>
<h2>Helping others</h2>
<p>The women we interviewed said they developed support networks with each other. One woman told us:</p>
<blockquote>
<p>You feel like, okay, that was such a hard experience, is there a way that we could make that a little less hard for the women who are going to go through it next time?</p>
</blockquote>
<p>Women wanted to tell their stories so others would better understand postnatal psychosis and could find it easier to get help.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, contact the following organisations for more information or support: <a href="https://www.panda.org.au/info-support/postnatal-psychosis">Perinatal Anxiety & Depression Australia</a> (PANDA), 1300 726 306; <a href="https://www.cope.org.au/">Centre of Perinatal Excellence</a>; <a href="https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/maternal-mental-health-and-wellbeing/bipolar-disorder">Beyondblue</a>,
1300 22 4636; Lifeline, 13 11 14. You can also contact your GP or go to your nearest hospital emergency department.</em></p><img src="https://counter.theconversation.com/content/170278/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diana Jefferies does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women can be reluctant to report worrying symptoms and when they do, these symptoms can be dismissed, our research shows.Diana Jefferies, Senior lecturer, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1670972021-09-23T19:48:44Z2021-09-23T19:48:44ZOutdoor exercise benefits new moms’ mental health during the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/422494/original/file-20210921-13-z4ljma.jpeg?ixlib=rb-1.1.0&rect=10%2C532%2C2003%2C1278&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women who engage in physical activity in the postnatal period report better mental well-being than those who are less physically active.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>The extended duration of the COVID-19 pandemic means more women will give birth during the pandemic, and some will have more than one pregnancy and postpartum experience. As physical activity researchers who advocate for exercise as medicine, we are studying the impact of exercise on well-being of postpartum women during the pandemic. </p>
<p>The COVID-19 pandemic has affected everyone’s day-to-day lives, but mothers have been especially challenged. Women have experienced a negative impact on mental well-being and <a href="https://doi.org/10.3390/ijerph17113899">physical activity behaviour</a>, with mothers being especially vulnerable with increased child-care responsibilities. New mothers in the postpartum phase are at an additional disadvantage due the heightened challenge of caring for infants.</p>
<h2>Postpartum challenges</h2>
<p>The <a href="https://doi.org/10.1111/j.1523-536X.2008.00238.x">postpartum phase</a> is often defined as the first six weeks after childbirth when post-pregnancy physical changes such as uterine shrinking and hormonal fluctuations are the greatest. These changes can also greatly affect the mental health of new mothers — the prevalence of depression is approximately 15 per cent. However, it is possible for new mothers to continue to experience post-partum effects for up to one year. </p>
<p>Since the onset of COVID-19, mental health issues have increased among postpartum women, with <a href="https://doi.org/10.3389/fgwh.2020.00001">41 per cent reporting depression and 72 per cent reporting moderate-to-high anxiety</a> (compared to 15 per cent and 29 per cent pre-pandemic). </p>
<p>Pre-pandemic challenges such as sleep deprivation, lack of self-care or medically complicated deliveries are now exacerbated. For example, <a href="https://doi.org/10.9778/cmajo.20210008">women who gave birth during the pandemic</a> may have experienced reduced direct maternal care, a lack of a home support system due to visiting restrictions and a lack of in-person breastfeeding support. </p>
<figure class="align-right ">
<img alt="A woman stretching outside beside a baby stroller." src="https://images.theconversation.com/files/422797/original/file-20210923-19-1ybhy79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/422797/original/file-20210923-19-1ybhy79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422797/original/file-20210923-19-1ybhy79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422797/original/file-20210923-19-1ybhy79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422797/original/file-20210923-19-1ybhy79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422797/original/file-20210923-19-1ybhy79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422797/original/file-20210923-19-1ybhy79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Exercising in nature has been associated with reductions in anxiety and stress, while being outside has been shown to increase enjoyment of exercise.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Physical activity is an effective therapy for anxiety and depression and may be beneficial for new mothers. As little as a single group <a href="https://doi.org/10.1007/s10995-009-0462-5">exercise session of 45 minutes can improve anxiety levels</a> in women without a history of mental illness. Women who engage in physical activity in the postnatal period <a href="https://doi.org/10.1023/B:MACI.0000037649.24025.2c">report better mental well-being</a> than those who are less physically active. </p>
<p>However, physical activity levels are <a href="https://doi.org/10.1300/J013v42n03_06">lower in the postpartum period</a> than prior to pregnancy. This is despite the American College of Obstetrics and Gynecologists recommending that women slowly <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period">return to physical activity four to six weeks after giving birth</a> and work their way up to the general physical activity guidelines of 150 minutes of moderate to vigorous physical activity per week. <a href="https://doi.org/10.1186/s12884-016-0908-x">Barriers in the postnatal period</a> include reduced motivation due to a lack of social support and childcare responsibilities.</p>
<h2>Pandemic-safe exercise solutions</h2>
<p>At 18 months into the pandemic with no end in sight, and safe indoor opportunities for exercise less accessible, <a href="https://sirc.ca/momsgotgame/">moms are in need of innovation</a>. An outdoor environment has the advantage of being easily accessible and COVID-19 safe, and having additional beneficial effects. For instance, exercising in nature, known as “<a href="https://doi.org/10.1186/2046-7648-2-3">green exercise</a>” has been associated with reductions in anxiety and stress, while being outside has been shown to increase enjoyment of exercise.</p>
<p>With the high degree of <a href="http://doi.org/10.1249/FIT.0000000000000264">safety in an outdoor environment</a>, could we support new moms with safe physical activity programming outdoors? We were interested in providing moms with the tools they need to return to physical activity safely and ensure they have the added competence to engage in physical activity with a new baby. If we want moms to thrive in this new normal we need to help them find their way back to movement and optimal mental well being. </p>
<figure class="align-center ">
<img alt="A woman seen from behind, jogging on a wooded path while pushing a double stroller" src="https://images.theconversation.com/files/422794/original/file-20210923-26-t7udob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422794/original/file-20210923-26-t7udob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422794/original/file-20210923-26-t7udob.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422794/original/file-20210923-26-t7udob.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422794/original/file-20210923-26-t7udob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422794/original/file-20210923-26-t7udob.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422794/original/file-20210923-26-t7udob.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Author Iris Lesser running with her two children in a stroller.</span>
<span class="attribution"><span class="source">(I. Lesser)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Working with a team at the University of the Fraser Valley, in the spring of 2021 we enrolled 21 women who were less than nine months postpartum in an eight-week, biweekly outdoor group exercise program. As a mother of two (including one born in the midst of the pandemic), Iris (one of the co-authors of this article) had both personal and professional interest in finding ways to meet the physical activity needs of new mothers. </p>
<p>Engaging in the program in an outdoor location with physical distancing allowed women to fully participate without risk of exposure to COVID-19. Mothers reported a decrease in depression after the program, along with an improvement in motivation and in meeting basic psychological needs. Perceived stress and anxiety also were reduced, but not significantly. </p>
<h2>Ongoing research</h2>
<p>These findings suggest that new mothers may experience an improvement in overall well-being after engaging in group exercise. This form of group exercise addressed a number of the common barriers to exercise participation during the postnatal phase. This includes the opportunity to bring their child to the program, engaging with other new mothers and the program being designed specifically for postpartum fitness. To determine the long-term effects on physical activity, we plan to conduct a followup at six months.</p>
<p>Supporting postpartum women with physical activity opportunities may help them exercise more in the postpartum period. This may further improve mental well-being in this at-risk population. </p>
<p>However, there is still a large gap in the literature regarding women’s postnatal physical activity experiences. We are currently recruiting women less than 12 months postpartum to <a href="https://www.surveymonkey.ca/r/movingwomenforward">complete an online survey</a> to help us learn more.</p><img src="https://counter.theconversation.com/content/167097/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Scott Lear has received funding from the Canadian Institutes of Health Research, the Heart and Stroke Foundation, Novo Nordisk, Hamilton Health Sciences and the Robert Wood Johnson Foundation.</span></em></p><p class="fine-print"><em><span>Iris Lesser does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women who are physically active in the postnatal period report better mental well-being than those who are less active, but the pandemic has made exercise less accessible.Iris Lesser, Assistant professor in kinesiology, University of The Fraser ValleyScott Lear, Professor of Health Sciences, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1545292021-02-05T16:15:56Z2021-02-05T16:15:56ZLockdown study finds undiagnosed mental health crisis among new mothers<figure><img src="https://images.theconversation.com/files/382591/original/file-20210204-20-1syxbx5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4079%2C1998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-little-boy-his-mothers-arms-770360815">Shutterstock</a></span></figcaption></figure><p>New mothers experienced worryingly high rates of depression and anxiety during the first lockdown, our new research has revealed. One of the major contributing factors to them feeling this way was the psychological impact of social distancing measures.</p>
<p><a href="https://doi.org/10.1016/j.jpsychires.2021.01.048">Our study</a> examined the psychological and social experiences of over 600 women with babies between birth and 12 weeks old during the first UK lockdown. </p>
<p>We wanted to understand prevalence rates of “clinically relevant” maternal depression and anxiety. By clinically relevant, we mean mothers who scored above a certain threshold on questionnaires normally used by clinicians when they assess and diagnose mental health conditions. </p>
<p>Usual rates of <a href="https://doi.org/10.3389/fpsyt.2017.00248">depression</a> and <a href="https://doi.org/10.1192/bjp.bp.116.187179">anxiety</a> after birth in the UK are around 15%. Our survey found similar rates, with 11% of women reporting they already had a current clinical diagnosis of depression and 18% reporting an existing clinical diagnosis of anxiety. However, when we explored this further we actually found that a much higher proportion were experiencing depression and anxiety – they just did not have a formal clinical diagnosis yet.</p>
<p>This was revealed when we examined how many of the mothers scored above the clinical threshold on the mental health questionnaires they completed. The findings were deeply concerning. We found that 43% of the women met the criteria for clinically relevant depression and 61% met the criteria for anxiety.</p>
<figure class="align-center ">
<img alt="Two graphs" src="https://images.theconversation.com/files/382525/original/file-20210204-16-ulzmrf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/382525/original/file-20210204-16-ulzmrf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382525/original/file-20210204-16-ulzmrf.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382525/original/file-20210204-16-ulzmrf.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382525/original/file-20210204-16-ulzmrf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382525/original/file-20210204-16-ulzmrf.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382525/original/file-20210204-16-ulzmrf.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our study showed high rates of undiagnosed depression and anxiety in new mothers during the first UK lockdown.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>This means that over a third of the women who met the criteria for depression and anxiety did not report having a current clinical diagnosis. </p>
<p>We also asked mothers whether they felt their feelings or relationships had been affected by the introduction of social distancing measures. Our analysis found that the perceived psychological impact of social distancing was the main contributing factor influencing feelings of depression and anxiety.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mental-disorders-are-common-for-new-parents-you-dont-have-to-go-through-it-alone-153243">Mental disorders are common for new parents – you don't have to go through it alone</a>
</strong>
</em>
</p>
<hr>
<h2>Disruption to motherhood</h2>
<p>It has been well established that the early postnatal period is a time of vulnerability for <a href="http://www.who.int/mental_health/prevention/genderwomen/en/">depression and anxiety</a>. But our study shows that maternal mental health after birth is compromised even further when combined with the stresses of the pandemic. </p>
<p>During the first UK lockdown in March 2020, new mothers experienced major <a href="https://www.rcog.org.uk/globalassets/documents/guidelines/2020-10-14-coronavirus-covid-19-infection-in-pregnancy-v12.pdf">disruptions to care</a> and support. These included reduced in person access to postnatal <a href="http://dx.doi.org/10.1037/tra0000629">health services</a> such as health visitor appointments, breastfeeding counselling and baby weigh-in clinics.</p>
<p>New mothers had reduced social support from <a href="https://doi.org/10.1111/1469-8676.12828">family and friends</a> due to lockdown restrictions. Birth partners were also not able to support the mother during the labour and birth of their baby due to <a href="https://doi.org/10.1111/1471-0528.16547">hospital visiting restrictions</a>.</p>
<p>While these measures were essential in minimising the spread of COVID-19, the <a href="https://doi.org/10.1111/aogs.13894">psychological risks</a> of having a baby during this time have received much less attention.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KBlVBOP7TGc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Our findings are even more troubling when considering the subsequent <a href="https://www.bbc.co.uk/news/health-54616688">lockdowns</a> which mothers have experienced since March 2020 – particularly during the winter months. The cumulative effect of lockdowns on maternal mental health has yet to be studied in detail. But we do not expect it will be any better now than it was last year.</p>
<h2>Protect maternal wellbeing</h2>
<p>We believe our study has highlighted a maternal mental health crisis which requires urgent attention and intervention. High rates of depression and anxiety during the pandemic have also been found in other <a href="https://doi.org/10.1002/ijgo.13249">developed countries</a>, indicating that UK mothers are not alone when it comes to mental health. </p>
<p>There is already consistent evidence that postnatal depression and anxiety are linked to a range of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0165032715309113">negative outcomes</a> outside of COVID-19 in terms of the <a href="https://doi.org/10.1016/j.infbeh.2018.02.005">health, development and behaviour</a> of children. There is a need for longitudinal research to address the short and long term consequences of the pandemic on maternal mental health.</p>
<p>We also know that reduced access to diagnosis and treatment during the pandemic is likely to further <a href="https://doi.org/10.3389/fgwh.2020.00001">affect mental health</a>, widening the gap between the prevalence of poor mental health and diagnosis and appropriate treatment. That is why we are calling for the government to protect maternal wellbeing by improving and maintaining access to perinatal mental health care during the pandemic and beyond. </p>
<p>Although NHS resources and staff are under unprecedented strain, it is crucial that mental health interventions are timely and meet mothers’ needs to prevent the escalation of symptoms and prevent additional burden to the NHS. Interventions must be developed with flexibility to ensure they work in both this and any future health crises. </p>
<p>One positive that can be drawn from our research is that over 80% of women did not experience changes in how they felt about their relationship with their baby. Perhaps this indicates that despite all the disruptions and restrictions encountered when having a baby during lockdown, the mother-infant relationship remains stable. This should provide some small comfort to those families waiting for some form of normality to return.</p><img src="https://counter.theconversation.com/content/154529/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Vicky Fallon is affiliated with The University of Liverpool. The authors to be credited for the original academic article from which piece was derived are: Dr Vicky Fallon, Miss Sian M Davies, Mr Sergio A Silverio, Miss Leanne Jackson, Dr Leonardo de Pascalis, and Dr Joanne A Harrold. </span></em></p><p class="fine-print"><em><span>Sergio A. Silverio and Siân Macleod Davies do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study examined the psychological and social experiences of over 600 women with babies between birth and 12 weeks during the first UK lockdown.Vicky Fallon, Lecturer in Health Psychology, University of LiverpoolSergio A. Silverio, Research Associate in Social Science of Women’s Health, King's College LondonSiân Macleod Davies, PhD Researcher, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1532432021-02-04T09:22:41Z2021-02-04T09:22:41ZMental disorders are common for new parents – you don’t have to go through it alone<figure><img src="https://images.theconversation.com/files/381109/original/file-20210128-19-nzhh80.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-mother-suffering-experiencing-postnatal-depression-1668000547">GrooveZ/Shutterstock</a></span></figcaption></figure><p>Having a baby is often a source of great happiness, but not always. Many new mothers experience mental disorders, and this can be an extremely distressing and stigmatising experience. </p>
<p>Sometimes when new mothers experience mental disorders, it leads to <a href="https://pubmed.ncbi.nlm.nih.gov/23525788/">feelings of guilt</a> about being “a failure” and the development of (usually unfounded) worries that it might lead to removal of the child. This may relate to the idealisation of motherhood in society; that there <a href="https://pubmed.ncbi.nlm.nih.gov/30849358/">has arguably become</a> an expectation that women experience “uninterrupted joy and rewarding sacrifice”. </p>
<p>And while there is not yet enough research on the impact of COVID-19 on maternal mental health, many aspects of the pandemic – such as social isolation, reduced face-to-face healthcare, worry over infection – may have made the last year <a href="https://pubmed.ncbi.nlm.nih.gov/33461593/">particularly hard</a> for new mothers.</p>
<h2>Perinatal depression</h2>
<p>Mental disorders during pregnancy or the year following childbirth – which together are known as “perinatal” mental disorders – affect around <a href="https://www.gov.uk/government/publications/chief-medical-officer-annual-report-2014-womens-health">one in five</a> women. In fact, those mental disorders that don’t involve symptoms of psychosis are one of the <a href="https://pubmed.ncbi.nlm.nih.gov/25455248/">most common</a> of all possible complications of childbearing.</p>
<p>The most common mental disorder childbearing women experience is depression, often with anxiety. Despite the common societal notions about motherhood, the evidence suggests that childbearing is <a href="https://pubmed.ncbi.nlm.nih.gov/25455248/">not protective against depression</a>. At any point during pregnancy and the first three months after birth, around <a href="https://pubmed.ncbi.nlm.nih.gov/16260528/">one in ten women</a> will experience it. </p>
<p>Although the term “postnatal depression” has become increasingly familiar over recent years, around a third of cases start in pregnancy. Of women depressed in pregnancy, <a href="https://pubmed.ncbi.nlm.nih.gov/23487258/">around a third</a> will have been depressed before they got pregnant.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1346503979602042880"}"></div></p>
<p>There is no single cause for perinatal depression. <a href="https://pubmed.ncbi.nlm.nih.gov/25455248/">Many factors</a> are thought to contribute but the pathways are not fully understood.</p>
<p>The major psychological contributor is a prior history of depression. The biggest social contributors are experiencing domestic violence, low socioeconomic status and major negative life events. Biologically, women with genetic predisposition, chronic physical illness and more children appear to be at higher risk as well.</p>
<p>Aside from the distress of depression itself, untreated persistent depression can be associated with <a href="https://pubmed.ncbi.nlm.nih.gov/25455250">long-term implications</a> for the physical, emotional and cognitive development of the child, although these effects are not inevitable. </p>
<p>Although rare, suicide among new mothers is <a href="https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2020/MBRRACE-UK_Maternal_Report_Dec_2020_v10.pdf">a leading cause</a> of death in the year following childbirth, particularly among women who are experiencing mental illness.</p>
<p>Despite this, it is important to note that most current evidence is based on data that wasn’t collected by following women and children longitudinally over time, so inferring cause and effect is difficult. The mechanisms of any link between perinatal depression and child development are <a href="https://pubmed.ncbi.nlm.nih.gov/25455250/">poorly understood</a>. The idea that a woman’s behaviour may negatively impact her child <a href="https://www.gov.uk/government/publications/chief-medical-officer-annual-report-2014-womens-health">has been highlighted</a> as a facet of “mother blaming culture” – the pathways involved are of course far more complex.</p>
<h2>What can be done?</h2>
<p>Depression is a treatable condition. The first step is recognising the problem. This can be hard, especially given the stigma still attached to pregnancy-related mental disorders. NHS England is currently rolling out <a href="https://www.england.nhs.uk/2018/05/nhs-england-pledges-specialist-mental-health-services-for-new-mums-in-every-part-of-the-country/">£365 million</a> of funding to expand perinatal mental health services across the UK, which will help many more women access support.</p>
<p>Depending on the severity of the depression, the impact on the woman and her treatment preferences, there are a range of treatment options that can be tailored to suit each person. These include guided self-help resources and talking therapies. Decisions around medication must be individualised and the risks and benefits carefully balanced. Care can be managed by a woman’s GP or, in more severe or complex cases, she can be referred to a specialist mental health service. </p>
<p>There is also increasing understanding of the role of partners in relation to maternal mental health and the mental health of partners themselves. The overall prevalence of depression in fathers is estimated to be around <a href="https://pubmed.ncbi.nlm.nih.gov/27475890/">8%</a>-<a href="https://pubmed.ncbi.nlm.nih.gov/20483973/">10%</a>.</p>
<figure class="align-center ">
<img alt="New father bends over crib looking exhausted." src="https://images.theconversation.com/files/381111/original/file-20210128-19-11fk0n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381111/original/file-20210128-19-11fk0n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381111/original/file-20210128-19-11fk0n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381111/original/file-20210128-19-11fk0n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381111/original/file-20210128-19-11fk0n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381111/original/file-20210128-19-11fk0n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381111/original/file-20210128-19-11fk0n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">New fathers also experience depression but are often stigmatised for doing so.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-father-upset-baby-suffering-post-1297511869">Lopolo/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Despite this, fathers <a href="https://pubmed.ncbi.nlm.nih.gov/30289768/">often experience</a> stigma and lack of access to mental health support. Similar to depression among new mothers, <a href="https://pubmed.ncbi.nlm.nih.gov/29331695/">research shows</a> depression in the months following childbirth can also impact on father-infant interactions and child development. </p>
<p>Conversely, increased social support and paternal involvement has been associated with reduced maternal depression and a positive impact on child development. This points to an increasing understanding of the importance of a whole family approach to supporting those with perinatal mental disorders, as well improving support and interventions for partners experiencing depression related to childbirth. The needs of <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/bjom.2014.22.7.495?ai=szui%3D11zzaf%3DT&">same-sex parents</a> must also be recognised.</p>
<p>Depression around the time of childbirth can be a common experience for new mothers, and although often overlooked, partners can also experience depression during this time too. Evidence-based treatments exist and improving early access to support for new families is paramount if the longer-term mental health and wellbeing of new parents and families is to improve.</p>
<hr>
<p><em>Some of the issues discussed in this article may be upsetting or resonate with you. Please talk to someone.</em></p>
<p><em>Help, support and information is available from your healthcare provider (general practitioners, midwives, health visitors and, in times of urgent need, A&E or 999). More information is available from the <a href="https://www.nhs.uk/conditions/post-natal-depression/">NHS</a> and <a href="https://maternalmentalhealthalliance.org/">Maternal Health Alliance</a>.</em></p><img src="https://counter.theconversation.com/content/153243/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Karyn Ayre is funded by a National Institute for Health Research Doctoral Research Fellowship (NIHR-DRF-2016-09-042). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
</span></em></p><p class="fine-print"><em><span>Dr Abigail Easter, King’s College London, is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
</span></em></p>It can be extremely distressing and stigmatising for a woman to experience a mental disorder around the time of childbirth.Karyn Ayre, NIHR Doctoral Research Fellow, King's College LondonAbigail Easter, Senior Research Fellow in Women's Mental Health, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1399792020-06-08T19:48:24Z2020-06-08T19:48:24Z20% of pregnant Australian women don’t receive the recommended mental health screening<figure><img src="https://images.theconversation.com/files/340241/original/file-20200608-176550-um0bbw.jpg?ixlib=rb-1.1.0&rect=34%2C0%2C5716%2C3500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>One-fifth of Australian women still don’t receive mental health checks both before and after the birth of their baby, our <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12999">research published today</a> has found. Although access to recommended perinatal mental health screening has more than tripled since 2000, thanks largely to government investment in perinatal mental health, our surveys show there is still some way to go before every mum gets the mental health screening needed.</p>
<p>Mental health issues are one of the most common complications of pregnancy. <a href="https://link.springer.com/chapter/10.1007/978-3-319-21557-0_11">Up to 20% of women</a> report anxiety or depression either during pregnancy or in the first year after their baby is born.</p>
<p>Maternal anxiety and depression are associated with problems including <a href="https://www.sciencedirect.com/science/article/pii/S0140673614612770">premature birth and low birth weight</a>. They can also impact child development through <a href="https://link.springer.com/article/10.1007/s00737-019-0941-7">effects on parenting practices</a> and <a href="https://www.annualreviews.org/doi/abs/10.1146/annurev.clinpsy.3.022806.091401">impaired bonding</a>. </p>
<p>In 2019, the cost of perinatal depression and anxiety was <a href="https://gidgetfoundation.org.au/wp-content/uploads/2019/11/Cost-of-PNDA-in-Australia_-Final-Report.pdf">estimated at A$877 million</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/postnatal-depression-is-a-continuation-of-existing-mental-health-problems-43006">Postnatal depression is a continuation of existing mental health problems</a>
</strong>
</em>
</p>
<hr>
<p>Australia has invested substantially in perinatal mental health screening. From 2001 to 2005, BeyondBlue’s <a href="https://www.beyondblue.org.au/docs/default-source/8.-perinatal-documents/bw0075-report-beyondblue-national-research-program-vol2.pdf?sfvrsn=2">National Postnatal Depression Program</a> screened 52,000 women and reached out to 200,000 families. </p>
<p>This was followed in 2008 by the <a href="https://www.beyondblue.org.au/docs/default-source/8.-perinatal-documents/bw0125-report-beyondblues-perinatal-mental-health-(nap)-full-report.pdf?sfvrsn=2">National Action Plan for Perinatal Mental Health</a> and the <a href="https://www.beyondblue.org.au/docs/default-source/8.-perinatal-documents/bw0125-report-beyondblues-perinatal-mental-health-(nap)-full-report.pdf?sfvrsn=2">National Perinatal Depression Initiative</a> in 2008-13, which supported universal screening and follow-up care, workforce training, and community mental health awareness programs. </p>
<p>National clinical practice guidelines on perinatal mental health care were <a href="https://www.beyondblue.org.au/docs/default-source/8.-perinatal-documents/bw0104-perinatal-slr-tools-q1-14.pdf?sfvrsn=2">introduced in 2011</a> and <a href="https://www.cope.org.au/health-professionals/health-professionals-3/review-of-new-perinatal-mental-health-guidelines/">updated in 2017</a>. In 2019 the federal government <a href="https://www.cope.org.au/wp-content/uploads/2019/05/COPE-Release_PM-Announcement.pdf">committed A$36 million</a> to support the emotional health and well-being of Australian women and families. </p>
<h2>Has it worked?</h2>
<p>The lack of national government data collection on perinatal mental health screening makes it hard to tell whether this public health investment has paid off. </p>
<p>Our study, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12999">published in the Australian and New Zealand Journal of Public Health</a>, is the first to track perinatal screening over time in a national sample. It included 7,566 mothers and 9384 children from the <a href="http://alswh.org.au/">Australian Longitudinal Study on Women’s Health</a>, which was started in 1996.</p>
<p>We asked mothers whether a health professional had asked them any questions about their emotional well-being, including completing a questionnaire. We mapped screening rates between 2000 and 2017 and compared them to policy initiatives and clinical practice guidelines.</p>
<p>We found the percentage of women being screened both during and after pregnancy has more than tripled since 2000, from 21.3% in 2000 to 79.3% in 2017. The percentage of women reporting they were not screened at all fell from 40.6% in 2000 to 1.7% in 2017.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/340237/original/file-20200608-176571-wvklw6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/340237/original/file-20200608-176571-wvklw6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/340237/original/file-20200608-176571-wvklw6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/340237/original/file-20200608-176571-wvklw6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/340237/original/file-20200608-176571-wvklw6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/340237/original/file-20200608-176571-wvklw6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/340237/original/file-20200608-176571-wvklw6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/340237/original/file-20200608-176571-wvklw6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Perinatal mental health screening rates and policy initiatives over time. The point marked ‘a’ is where the proportion of women who are not screened at all begins to decline; point ‘b’ is where recommended screening becomes most common.</span>
<span class="attribution"><span class="source">Aust NZ J. Pub. Health</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our data shows a clear improvement in access to mental health screening. There was a decline in the percentage of women who were only screened once, and an increase in the percentage who were screened both during and after pregnancy. Notably, this widespread transition from single to double screening (the point marked “b” in the graph above) coincided with the introduction of the Perinatal Mental Health National Action Plan and the National Perinatal Depression Initiative, suggesting these policies have delivered real improvements.</p>
<p>However, the timing of this transition differed by state. For example, it happened in 2008 in New South Wales, 2009 in Victoria, and 2010 in Queensland. This might be due to state-based differences in the previous policies and clinical practice, and readiness to implement national initiatives.</p>
<h2>What is still to be done?</h2>
<p>While our results show there’s been real improvement, it nevertheless remains the case that in 2017, one in five women didn’t receive the recommended mental health screening. </p>
<p>What’s more, women who had reported emotional distress were 23% less likely, and older mothers 35% less likely, to be screened both during and after pregnancy. </p>
<p>Screening is not yet universal – and it needs to be.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/like-mother-like-child-good-maternal-mental-health-means-happier-babies-2579">Like mother, like child: good maternal mental health means happier babies</a>
</strong>
</em>
</p>
<hr>
<p>There are <a href="https://link.springer.com/chapter/10.1007/978-3-319-21557-0_11">barriers</a> to screening, including lack of time and potential over-diagnosis. Also, some women who screen positive for mental health problems might not engage in <a href="https://www.sciencedirect.com/science/article/pii/S0002937810000050">treatment</a>. However, women who are asked about their current and past mental health are up to 16 times more likely to receive a referral for further <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12067">support</a>. We need to ask mothers about their mental health. </p>
<p><a href="https://www.cope.org.au/wp-content/uploads/2018/05/COPE-Perinatal-MH-Guideline_Final-2018.pdf">Clinical practice guidelines</a> recommend screening for symptoms of anxiety and depression during pregnancy and during the first year after giving birth. This can be done by trained health professionals. Access to well-integrated and culturally safe care is essential.</p>
<p>Systematic national data collection is required if clinical best practice is to be monitored into the future. Perinatal mental health items have been developed as part of the National Maternity Data Development Project, and should be progressed as a <a href="https://www.aihw.gov.au/reports/mothers-babies/enhancing-maternity-data-collection-reporting-nmdd/contents/table-of-contents">priority</a>. </p>
<p>Women have regular contact with the health system both before and after giving birth. This offers a great chance to identify women who need extra mental health support, and it is too important to be missed.</p><img src="https://counter.theconversation.com/content/139979/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gita Mishra receives funding from National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Nicole Reilly receives Fellowship funding from Australian Rotary Health and the University of Newcastle. </span></em></p><p class="fine-print"><em><span>Katrina Moss does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The percentage of women receiving the recommended perinatal mental health screening has tripled since 2000 – but one in five women are still missing out.Katrina Moss, Postdoctoral Research Fellow in maternal and child health, The University of QueenslandGita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of QueenslandNicole Reilly, Postdoctoral research fellow, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1123502019-03-22T10:07:54Z2019-03-22T10:07:54ZThis is what postnatal depression really feels like<figure><img src="https://images.theconversation.com/files/263865/original/file-20190314-28512-y2kvkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Motherhood can be a source of joy, but it can also pose difficulties and challenges – particularly, in the postnatal period. It is a time when some mothers’ emotional and physical endurance is pushed to the limit. </p>
<p>About 10% of pregnant women and 13% of women who have just given birth experience a mental illness, <a href="https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/">primarily depression and anxiety</a>. In developing countries 20% of mothers experience clinical depression after childbirth. </p>
<p>Mothers who have mental health problems after giving birth, face the dual challenges of managing motherhood alongside their health issue. This balancing act can cause an internal conflict – but fears of being judged and shame around what they are experiencing can act as a barrier, which stops many women from seeking help. </p>
<p>There is an expectation that having a baby will result in the rosy glow of motherhood. But <a href="https://www.nhs.uk/conditions/post-natal-depression/symptoms/">postnatal depression</a> can leave many women with a persistent feeling of deep sadness, and a loss of interest in life. This may reduce their ability to care for their baby, or may leave them with thoughts of self-harm or even suicide. </p>
<h2>A mother’s mask</h2>
<p>We conducted interviews with mothers with mental health problems during the postnatal period. These were gathered as part of a larger study, which explored the family focused practice of <a href="https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/health-visitors-family-focused-practice/">health visitors who work with these women</a>. </p>
<p>We found that while mothers wanted support, there were barriers to accepting it. The mothers we spoke to felt fear, shame and guilt about being a mother with poor mental health. These feelings led to the mothers covering up their deteriorating mental health, from family, friends and professionals. </p>
<p>And with an expectation of happiness, the reality of parenthood mixed with suffering from postnatal depression can be a hard one to accept – as one of the mothers we spoke to explained:</p>
<blockquote>
<p>I didn’t feel a connection to the baby, and that was stressing me out even more. I was thinking I need to feel something here; I need to feel like fireworks going off here. (Mother of one, age 37)</p>
</blockquote>
<p>With this internal conflict, mothers describe feelings of guilt and shame about their mental health problems, coupled with a belief that they were not deserving of motherhood:</p>
<blockquote>
<p>I truly at times looked at these two kids and thought, you deserve better than me who is sitting here and can’t get dressed for days. What sort of life am I giving you?. (Mother of two, age 34)</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/263867/original/file-20190314-28496-fzsv6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/263867/original/file-20190314-28496-fzsv6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/263867/original/file-20190314-28496-fzsv6m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/263867/original/file-20190314-28496-fzsv6m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/263867/original/file-20190314-28496-fzsv6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/263867/original/file-20190314-28496-fzsv6m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/263867/original/file-20190314-28496-fzsv6m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Postnatal depression can make it difficult for new mothers to cope.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The mothers in our study also spoke about fearing the judgement of society, believing that society equates mental health problems with bad parenting: </p>
<blockquote>
<p>I was getting more and more anxious. They’re looking at me, they’re thinking I’m a terrible mother, I am a terrible mother. (Mother of three, age 38)</p>
</blockquote>
<p>One of the mother spoke about the fears that her children would be taken away from her if she told people how she was really feeling – believing that people would view her as “not being a fit mummy”. Many of the mothers we spoke to talked about going to great lengths to hide their struggles with their mental health – from both their family, friends and the outside world: </p>
<blockquote>
<p>You have that mask that you put on for society. And then you have days where you just don’t want to wear that mask so you just stay in the house. (Mother of two, age 32)</p>
</blockquote>
<p>The mothers also felt they are judged more harshly than fathers, due to widely held assumptions that women have instinctual love for their children. </p>
<h2>The reality of motherhood</h2>
<p>To some extent, western society has moved beyond traditional gender roles, yet mothers still predominately take on the bulk of care giving responsibilities for children. And as our research shows mothers feel stigmatised and fear judgement – which can result in them covering up their deteriorating mental health. </p>
<p>Our research also highlights how a lack of openness around mental health problems, can mean these women will not be identified and cannot receive appropriate support. Without support there is a risk that their mental health will deteriorate further, potentially resulting in negative outcomes for all the family.</p>
<p>Services need to develop a deeper understanding of the impact of poor mental health on mothers and provide opportunities for mums to openly discuss parenting and mental health, in a judgement free environment. </p>
<p>Assumptions and expectations of motherhood, also need to be re-examined, and discussed more openly with the general public, as the rosy glow of motherhood does not reflect the universal experience of all mothers.</p><img src="https://counter.theconversation.com/content/112350/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Leonard receives funding from the Department of Employment and Learning Northern Ireland. </span></em></p><p class="fine-print"><em><span>Anne Grant and Mark Linden do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>About 10% of pregnant women and 13% of women who have just given birth experience a mental illness.Rachel Leonard, Postgraduate research student in the School of Nursing and Midwifery, Queen's University BelfastAnne Grant, Lecturer in the School of Nursing and Midwifery, Queen's University BelfastMark Linden, Lecturer School of Nursing and Midwifery, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1114752019-02-28T15:48:04Z2019-02-28T15:48:04ZEmergency caesareans increase risk of postnatal depression in new mothers, our research suggests<figure><img src="https://images.theconversation.com/files/261077/original/file-20190226-150721-1fk797t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Becoming a mother, especially for the first time, has its challenges – and it starts with giving birth. </p>
<p>From woman to woman, the birth experience can vary tremendously – and one of the most important factors that determines the experiences new mothers have is the delivery method. In the UK about <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2016-17">16% of mothers</a> have a an emergency caesarean section, which is performed when the life of the baby or the mother is at risk. </p>
<p>Research has shown the impact this procedure has on mothers’ bodies – including risk of infections, persistent wound and abdominal discomfort – but less is known about the possible consequences for their mental health. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0167629617308937">My study</a> analyses the effect of having an unplanned caesarean on new mothers’s psychological well-being. We used a representative sample of 5,000 new mothers living in the UK. It found that giving birth through an emergency caesarean increases the risk of developing postnatal depression in the first nine months after childbirth by about 15%.</p>
<h2>Increasing risk</h2>
<p>The number of women giving birth by cesarean section has risen over the years. In England, for example, for every 100 new babies, 26 are born through a caesarean section. Compare this with the 1990s, when only <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2016-17">12-15%</a> of deliveries were cesareans (emergency and elective).</p>
<p>According to <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2013-14">NHS estimates</a>, in 2013-2014 about 42,000 first time mothers delivered their baby through this procedure – and most of these were emergency deliveries (31,500). Similar phenomenons have also been observed in other countries. </p>
<h2>Long-term impact</h2>
<p>Postnatal depression can have a profound and long-term impact on the lives of new mothers. It can lead to a <a href="https://www.sciencedirect.com/science/article/pii/0277953693903385">deterioration of their relationship</a> with their partner and limit their <a href="https://books.google.co.uk/books?hl=en&lr=&id=eam6Sagya_wC&oi=fnd&pg=PP1&ots=rvDy1k_uxs&sig=HDAUdsFrzRPawi8RQjXM-4iEX6w&redir_esc=y#v=onepage&q&f=false">ability to work</a>. </p>
<p>Postnatal depression can also become a chronic condition affecting the way mothers look after their children. Indeed, <a href="https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/">previous studies</a> have found <a href="https://pediatrics.aappublications.org/content/115/2/306">lower immunisation rates</a> and higher hospital admissions among children of depressed mothers. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Postnatal depression is a type of depression that many parents experience after having a baby.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Mothers giving birth through an emergency caesarean are different from mothers who give birth naturally in many ways. For example, older or overweight women are more likely to have an emergency caesarean. Complications during labour due to the baby’s health may result in an emergency caesarean. And this can also have an effect on the mother’s psychological well-being, as she may worry for her baby’s health. </p>
<p>In the study, it was important to account for these differences, because what we were interested in was whether emergency caesareans increases the risk of postpartum depression – rather than the effect of these existing factors. </p>
<h2>More support</h2>
<p>We considered all these factors and concluded that women giving birth through an emergency caesarean were 15% more likely to develop postnatal depression. This is a large percentage, when you consider that about one in every three mothers experience some form of postnatal depression after childbirth.</p>
<p>Exactly why this happens, is still unknown. But previous studies have argued that <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12168">longer and more difficult postpartum recovery</a> for mothers who had a caesarean delivery, as well as the <a href="https://www.sciencedirect.com/science/article/pii/0277953693903385">separation of mothers from their babies</a> directly after the delivery may cause this phenomenon. Another explanation is that because emergency caesareans are unexpected events, <a href="https://www.sciencedirect.com/science/article/pii/S0277953607000779">they may be associated with loss of control</a> and with a birth experience that is very different from what was expected. </p>
<p>Of course, in many cases, emergency deliveries cannot be avoided. But the results of this research highlight the importance of providing additional psychological support to women who have an emergency caesarean. This is important, because supporting mothers who give birth through an emergency caesarean may not only help to reduce the risk of postnatal depression and improve their well-being, but it could also benefit their families, and in particular their children.</p><img src="https://counter.theconversation.com/content/111475/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Valentina Tonei receives funding from the British Academy through a BA Postdoctoral fellowship (Award reference: pf160106). This research was supported by an ESRC PhD scholarship.
</span></em></p>New study finds that giving birth through an emergency caesarean increases the risk of developing postnatal depression in the first nine months after childbirth by about 15%.Valentina Tonei, Research Associate in the Department of Economics, University of YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1082562018-12-06T18:57:52Z2018-12-06T18:57:52ZMen get postnatal depression too, and as the mother’s main support, they need help<figure><img src="https://images.theconversation.com/files/249150/original/file-20181206-186052-mrwggn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men also experience postnatal mental health and adjustment issues.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>England’s <a href="https://www.england.nhs.uk/2018/12/partners-of-new-mums-with-mental-illness-set-to-get-targeted-support-on-the-nhs/">National Health Service</a> (NHS) this week announced it will offer mental health screening and treatment for new and expectant fathers whose partners are suffering from mental illness. The NHS described this as a “radical action to support families”, and it certainly is an unusual step. </p>
<p>In Australia, screening mothers for mental illness before and after birth is standard, but fathers are not routinely assessed at any point. The idea new fathers could also have mental health issues related to the birth may seem odd. But there is increasing evidence men experience postnatal mental health and adjustment issues that deserve attention.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dads-get-postnatal-depression-too-55829">Dads get postnatal depression too</a>
</strong>
</em>
</p>
<hr>
<p>It is true that the rate of depression for new fathers, <a href="https://jamanetwork.com/journals/jama/fullarticle/185905">estimated at 10%</a>, is around half that of mothers. But that still amounts to more than <a href="http://www.abs.gov.au/ausstats%5Cabs@.nsf/0/8668A9A0D4B0156CCA25792F0016186A?Opendocument">30,000 babies</a> who start life each year with a father who is miserable and irritable on top of the normal fatigue and stress that come with a newborn. This has negative short- and long-term effects on the mother and child.</p>
<h2>Father’s mental health affects the baby</h2>
<p>Of 1,500 men surveyed by <a href="https://www.beyondblue.org.au/docs/default-source/research-project-files/bw0313-beyondblue-healthy-dads-full-report.pdf?sfvrsn=6f0243ea_0">mental health organisation beyondblue</a> in 2015, one in four said only mothers could get postnatal depression. Health professionals too can be so focused on the risk to mothers that they overlook fathers’ mental health. </p>
<p>But having a stressed and depressed father can have serious implications for infants and relationships. These dads are more likely to be withdrawn and speak with less warmth to their infant. Compared to those who are well, fathers who are depressed are also more likely to <a href="http://pediatrics.aappublications.org/content/127/4/612.short">use physical discipline</a> on even one-year-old babies and participate less in tasks such as reading storybooks. </p>
<p>We now know this can lead to long-term consequences for the child. Compared to children of fathers without signs of depression, those whose fathers show signs of depression in the first year will have <a href="https://www.mja.com.au/system/files/issues/195_11_121211/fle10192_fm.pdf">three times the risk</a> of behavioural problems in preschool and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890856709623947">twice the risk</a> of mental health problems once at school. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/childrens-well-being-goes-hand-in-hand-with-their-dads-mental-health-102347">Children’s well-being goes hand in hand with their dads’ mental health</a>
</strong>
</em>
</p>
<hr>
<p>Leaving aside the effect on children, there are <a href="https://www2.deloitte.com/au/en/pages/economics/articles/perinatal-depression-australia-cost.html">economic costs</a> of fathers’ depression, estimated at A$17.97 million. Further indirect productivity costs add A$223.75 million to the bill.</p>
<p>And fathers’ mental health affects that of mothers. When the predictors of mothers’ depression are examined, fathers’ mental health <a href="https://link.springer.com/article/10.1007/s00737-016-0598-4">stands out</a> among the most influential.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/249155/original/file-20181206-186055-cobs97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/249155/original/file-20181206-186055-cobs97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249155/original/file-20181206-186055-cobs97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249155/original/file-20181206-186055-cobs97.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249155/original/file-20181206-186055-cobs97.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249155/original/file-20181206-186055-cobs97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249155/original/file-20181206-186055-cobs97.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249155/original/file-20181206-186055-cobs97.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Depressed or irritable fathers are less likely to read with their children.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/EQlTyDZRx7U">Picsea/Unsplash</a></span>
</figcaption>
</figure>
<p>The NHS will not target all fathers with mental health issues, just those where the mothers have depression, anxiety or a more serious mental illness. This strategy may be simply a way for the NHS to dip a toe into the water of fathers’ mental health. But there is a logic to the approach in that the relationship between the parents may yield the biggest gain for the health dollar. </p>
<h2>Helping fathers will help mothers</h2>
<p>Treating these dads has multiple benefits. The emotional and practical support a father can offer to his mentally ill partner <a href="https://www.sciencedirect.com/science/article/abs/pii/S0884217515310984">can contribute</a> to her healing. Mothers with mental illness <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-016-0344-0">identify their partner</a> as their main support. </p>
<p>And his involvement in caring for their infant can have dual benefits. The mother is relieved of some responsibility for the care and the impact of the impaired care by the mother can be lessened. Supporting fathers in this role and improving their confidence in parenting has major benefits. </p>
<p>Deciding to screen fathers is the first step. The hard part will be to engage men in screening and then follow through with treatment when there are many barriers. Fathers have relatively little contact with health services, they return to work soon after the birth and there is stigma to combat. Many <a href="https://journals.sagepub.com/doi/abs/10.1177/1557988315581395">don’t recognise their own symptoms</a> of mental ill health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-had-postnatal-depression-as-a-new-father-and-know-why-mental-health-checks-for-dads-should-be-expanded-108123">I had postnatal depression as a new father and know why mental health checks for dads should be expanded</a>
</strong>
</em>
</p>
<hr>
<p>Australia is ahead of the UK in this regard. Beyondblue has developed <a href="https://www.beyondblue.org.au/who-does-it-affect/men">effective campaigns</a> that have <a href="https://www.beyondblue.org.au/media/news/news/2013/06/20/the-shed-online-evaluated-as-a-success">raised awareness</a> of male depression. With funding from Movember, it has also supported <a href="https://www.sms4dads.com/">SMS4dads</a> sending texts to fathers during and after the pregnancy. The texts <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4978-0">provide information</a> and links to online resources to help fathers develop healthy attachments with their infants and offer support to the mother. </p>
<p>We <a href="https://cdn.ymaws.com/waimh.org/resource/resmgr/images/congresses/2018/imhj_waimh_congress_abstract.pdf">piloted sending such texts</a> to both mothers with severe mental illness and their partners in rural Queensland. We found that fathers were happy to get the texts for up to six months and commented on the usefulness of the messages.</p>
<h2>Australia should screen fathers too</h2>
<p>The UK has decided that perinatal mental health, with fathers included, will become an ongoing feature of its long-term national health plan. In Australia, we should also set this as a focus and develop approaches to true early intervention and mental health support that benefit parents and infants.</p>
<p>We should use the opportunities of the upcoming <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2018-hunt71.htm">National Men’s Health Strategy 2020-2030</a>, the <a href="https://www.abc.net.au/news/2018-10-24/victoria-daniel-andrews-royal-commission-into-mental-health/10423104">Royal Commission into Mental Health in Victoria </a> and the <a href="https://www.pc.gov.au/inquiries/current/mental-health">Productivity Commission’s inquiry</a> into the effects of mental health on workplace and community participation. Supporting men in early parenting is a key national strategy in promoting community mental health.</p><img src="https://counter.theconversation.com/content/108256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Fletcher receives funding from government and non-government organisations. He is Chief Investigator of the SMS4dads research project. </span></em></p><p class="fine-print"><em><span>Jacqui Macdonald receives funding from government and non-government organisations and works on life-course and intergenerational studies of family psychosocial wellbeing. </span></em></p><p class="fine-print"><em><span>Louise Newman receives funding from government and non-government organisations and works on perinatal and infant mental health projects. </span></em></p>Having a stressed and depressed father can have serious implications for infants and relationships. And supporting a father who may be experiencing mental ill health means supporting the mother too.Richard Fletcher, Associate professor, University of NewcastleJacqui Macdonald, Senior lecturer, Deakin UniversityLouise Newman, Director of the Centre for Women’s Mental Health at the Royal Women’s Hospital and Professor of Psychiatry, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1081232018-12-04T14:23:56Z2018-12-04T14:23:56ZI had postnatal depression as a new father and know why mental health checks for dads should be expanded<figure><img src="https://images.theconversation.com/files/248505/original/file-20181203-194938-30q9ev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Postnatal depression affects between 8-11% of new fathers.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/511881799?src=nB5eCe-as1_HbxwlM2LHKA-1-1&size=medium_jpg">Halfpoint/Shutterstock</a></span></figcaption></figure><p>New and expectant fathers will be offered mental health assessments if their partner is suffering from depression or anxiety, NHS England recently <a href="https://www.england.nhs.uk/2018/12/partners-of-new-mums-with-mental-illness-set-to-get-targeted-support-on-the-nhs/">announced</a>. </p>
<p>The NHS described the plan as “radical” and a “landmark move”. While it is vital that fathers whose partners are suffering get support, the plan still falls far short of what new fathers need. I would know. <a href="https://thepsychologist.bps.org.uk/dads-get-sad-too">I was diagnosed</a> with postnatal depression after my son was born and under the proposed plans, my symptoms would still be missed by the NHS.</p>
<p>Postnatal depression is a non-psychotic depressive disorder that can occur after the birth of a child. Between <a href="https://www.ncbi.nlm.nih.gov/books/NBK11838/">6-13% of new mothers</a> will suffer from postnatal depression, with symptoms including persistent sadness or low mood, feelings of hopelessness and worthlessness, loss of interest in activities that were previously enjoyed, and thoughts of suicide. </p>
<p>Postnatal depression in new mothers results in <a href="https://link.springer.com/article/10.1007/s10995-008-0312-x">poorer mother-child attachment</a>, <a href="https://onlinelibrary.wiley.com/doi/full/10.1046/j.1523-536X.2003.00242.x">shorter breastfeeding duration</a> and <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2670696">poor child development</a>. The cost to society is huge. In the UK, every case of maternal depression costs, on average, <a href="http://eprints.lse.ac.uk/59885/">£74,000</a>, with the bulk of this relating to the negative effects on the child.</p>
<p>Some people, including scientists, <a href="https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1547-5069.2002.00227.x">used to think</a> that postnatal depression was mainly a result of hormonal changes post-birth, or experiences that are specific to women, including delivery complications or unsuccessful breastfeeding. But there is now wider recognition that postnatal depression can also affect new fathers. In fact, recent studies have suggested that between <a href="http://pediatrics.aappublications.org/content/pediatrics/118/2/659.full.pdf">8-11% of new fathers</a> suffer from postnatal depression. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/postnatal-depression-men-get-it-too-87567">Postnatal depression: men get it too</a>
</strong>
</em>
</p>
<hr>
<p>And as with maternal postnatal depression, the condition can seriously impair <a href="https://www.sciencedirect.com/science/article/pii/S0163638316301862">father-child attachment</a> and the nature of a <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/depressed-fathers-speech-to-their-3monthold-infants-a-study-of-cognitive-and-mentalizing-features-in-paternal-speech/1992BEC4FE02638F3A33E9DB8FE08103">father’s interactions with their child</a>, and it can also increase <a href="https://www.sciencedirect.com/science/article/pii/S0165032715312404">behavioural and emotional difficulties</a> in the child. Fathers with depression are also about <a href="https://www.sciencedirect.com/science/article/pii/S0165032711000218">20 times</a> more likely to consider suicide compared with non-depressed fathers.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/248511/original/file-20181203-194925-168q36o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/248511/original/file-20181203-194925-168q36o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/248511/original/file-20181203-194925-168q36o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/248511/original/file-20181203-194925-168q36o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/248511/original/file-20181203-194925-168q36o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/248511/original/file-20181203-194925-168q36o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/248511/original/file-20181203-194925-168q36o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Postnatal depression in dads can lead to behaviour problems in the child.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/62828830?src=DXHpAs95gm_DKC6w-JlJqA-1-18&size=medium_jpg">Cresta Johnson/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why dads get sad</h2>
<p>Many factors are known to contribute to postnatal depression in new fathers. The <a href="https://www.sciencedirect.com/science/article/pii/S0266613816000231">most common</a> is maternal postnatal depression. Fathers whose partners have postnatal depression are about two-and-a-half times more likely to have symptoms of depression six weeks after the birth of a child. This is why NHS England’s plan to screen fathers whose partner is suffering from mental health conditions is important and will mean many more men will receive the care they need.</p>
<p>But this focus still ignores new fathers, like me, whose partners do not have a pre-existing mental health condition, such as anxiety or depression. Instead, a more holistic account of the mental health of new fathers would consider their <a href="http://journals.rcni.com/primary-health-care/paternal-postnatal-depression-an-overview-for-primary-healthcare-professionals-phc.2016.e1120">previous history</a> of mental illness and the psychological and social context of fatherhood. For example, men often report <a href="https://journals.sagepub.com/doi/abs/10.1177/1557988315574740">large discrepancies</a> between the expectations and realities of childbirth in the postnatal period. And men who experience <a href="https://link.springer.com/article/10.1007/s11199-016-0629-7">greater difficulties</a> with childcare.</p>
<p>New fathers are also more likely than new mothers to return to work sooner and, in many parts of society, men are still <a href="https://journals.sagepub.com/doi/abs/10.1177/1557988315574740">expected</a> to be the breadwinners. Yet new fathers are also expected to play an <a href="https://www.tandfonline.com/doi/abs/10.5172/conu.673.31.1.57">active role</a> in childcare, and difficulties managing an early return to work with childcare responsibilities can contribute to symptoms of depression. </p>
<p>New fathers can also have difficulty <a href="https://journals.sagepub.com/doi/abs/10.1177/107484079600200306">developing an emotional bond</a> with their child compared with mothers, which may increase feelings of helplessness.</p>
<p>But when new fathers get depressed, they are still <a href="https://www.sciencedirect.com/science/article/pii/S0891524512002209">less likely than new mothers</a> to have their symptoms caught and are more likely to go untreated. In part, this may be because men are <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0049779">reluctant to disclose</a> symptoms of mental ill health, especially if such disclosures are seen as inconsistent with ideals of masculinity. But it may also be because healthcare practitioners do not recognise depression in new fathers or <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0726-6">provide opportunities</a> for new fathers to raise concerns about their mental health.</p>
<p>In the UK, for example, the <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/johv.2017.5.3.143">tradition of health visiting</a> is heavily focused on mothers and children, and some health visitors are reluctant to address postnatal depression in men. As a result, fathers end up <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1471-6712.2006.00383.x">feeling overlooked</a> following the birth of a child and their experiences rendered <a href="https://thepsychologist.bps.org.uk/dads-get-sad-too">invisible</a>. </p>
<p>The invisibility of depressive symptoms in new fathers is important because it often forces men to manage their symptoms on their own, leaving them frustrated when they are unable to do so. New fathers may also end up questioning the legitimacy of their depressive experiences and <a href="https://thepsychologist.bps.org.uk/dads-get-sad-too">avoid or delay</a> seeking help, as a result.</p>
<p>While the plans by NHS England are an important first step, there is a risk that many new fathers will continue to be let down through under-diagnosis or a lack of attention to the mental healthcare needs of new fathers. Instead, what is needed is <a href="https://journals.sagepub.com/doi/abs/10.1177/1557988314526614">routine screening</a> of new fathers for depression and other mental health conditions, so that all new parents are treated equally. This, in turn, requires that healthcare practitioners who are most likely to meet new fathers have the appropriate <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/johv.2017.5.3.143">education, training and time</a> to engage with fathers too.</p><img src="https://counter.theconversation.com/content/108123/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Viren Swami does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>NHS plans to screen at risk fathers for postnatal depression.Viren Swami, Professor of Social Psychology, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1037882018-10-05T12:27:45Z2018-10-05T12:27:45ZBreastfeeding is good for mothers’ mental health – but those who struggle need support<figure><img src="https://images.theconversation.com/files/238746/original/file-20181001-195282-1jyyaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/frustrated-mother-suffering-post-natal-depression-238716724?src=-5g6AuMBP2JWkzsk9uZ1vA-1-16">SpeedKingz/Shutterstock</a></span></figcaption></figure><p>If you believed some newspapers you would think that breastfeeding was inherently bad for maternal mental health. Headlines regularly shout about “<a href="https://www.channel4.com/news/bressed-pressure-to-breastfeed-has-gone-to-far">pressure to breastfeed</a>” and “<a href="https://www.dailymail.co.uk/femail/article-3255275/Thought-breastfeeding-bullies-gone-away-nastier-ever.html">breastfeeding bullies</a>” making mums feel anxious and miserable. Calls are made for breastfeeding promotion <a href="https://www.theguardian.com/commentisfree/2017/mar/28/an-unrealistic-pressure-mothers-on-what-its-like-to-breastfeed">to stop</a> due to the perceived risk of ruining the motherhood experience. </p>
<p>But breastfeeding does not damage maternal mental health. In fact, a good breastfeeding experience can do marvellous things for women’s well-being. Alongside reducing risk of <a href="https://www.researchgate.net/profile/Np_Magula/publication/6076615_Breastfeeding_and_Maternal_Health_and_Infant_Health_Outcomes_in_Developed_Countries/links/557651a508aeacff1ffe62c2.pdf">reproductive cancers, heart disease and diabetes</a>, it can help mothers feel <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2010.0097">empowered, confident</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S0277953605002716">heal birth trauma</a> too. Breastfeeding hormones are even thought to help <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6">reduce the impact of stress and sleep deprivation</a> upon the body. It’s no wonder that <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1552-6909.2002.tb00063.x">numerous</a> <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6">studies</a> have found that when breastfeeding is going well, a woman’s <a href="https://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00007">risk of postnatal depression is lower</a>. </p>
<p>But when women are unable to breastfeed as they had expected their <a href="http://pediatrics.aappublications.org/content/123/4/e736.short">mental health can be badly affected</a>. Having a difficult breastfeeding experience and feeling forced to stop can leave women feeling <a href="http://journals.sagepub.com/doi/abs/10.1177/0890334407312002">devastated, grief stricken and very, very angry</a>.</p>
<p>But, I repeat, the problem is not breastfeeding itself. Instead it is the <a href="https://www.huffingtonpost.co.uk/entry/lack-of-support-for-breastfeeding-mothers-in-britain-is-inhumane_uk_5b5b0bb2e4b0b15aba9813f9">lack of support and investment</a> in infant feeding, new mothers and families more broadly. More than two-thirds of mothers who stop breastfeeding in the first few weeks do so because they <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">needed more support, had pain, or difficulty latching a baby on</a>. However, lack of investment in health services means that mothers are often forced to get on with it by themselves – often with the further blow of being told “the main thing is your baby is being fed” – rather than have the one-to-one support they actually need. </p>
<p>In fact, issues such as not getting enough <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1523-536X.2010.00446.x">professional help</a>, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12219">exhaustion</a> and <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0581-5">misinformation</a> mean that more than half of UK babies have had formula by the <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">end of their first week</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A positive breastfeeding experience for both mother and child.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/horizontal-shot-happy-young-mixed-race-1104404429?src=y3YDVRuiHydKAhGA631m0Q-1-6">shurkin_son/Shutterstock</a></span>
</figcaption>
</figure>
<p>Difficult experiences also raise the risk of postnatal depression, over and above the hormonal implications of not breastfeeding. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12832">Our research</a> – conducted with 217 mothers who stopped breastfeeding in the first few months – shows where women were ready to stop, or stopped for reasons that they perceived to be positive, their mental health was not affected. But when they stopped because of pain, physical difficulties, or because they couldn’t get the support they needed, their risk of depression was much higher. </p>
<p>This study expanded on a <a href="http://pediatrics.aappublications.org/content/123/4/e736.short">large body of research</a> showing a link between a short period of breastfeeding and postnatal depression. The findings are perhaps unsurprising. Experiencing <a href="https://www.sciencedirect.com/science/article/pii/S1526590011004871">pain and exhaustion</a> are both linked to increased risk of depression – before you add on <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-6712.2007.00572.x">shattered expectations</a> and often <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-9566.2007.01020.x">a lack of advice about what to do next</a>.</p>
<p>What is confusing is that investment still isn’t being made to support women in reaction to this. We know that breastfeeding <a href="https://www.sciencedirect.com/science/article/pii/S0140673615010247">protects maternal and infant health</a>. We know it <a href="https://adc.bmj.com/content/early/2014/11/12/archdischild-2014-306701.short">saves money</a> for the healthcare system. We know the majority of women <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">want to do it</a> – and lots, once they get past the early weeks, find it <a href="https://www.sciencedirect.com/science/article/pii/S0266613809001211">simpler, more convenient and cost-effective</a>. And we know the potentially damaging effect on their mental health if they cannot breastfeed. </p>
<p>It’s not as if we don’t know <a href="http://www.pinterandmartin.com/breastfeeding-uncovered.html">why women are struggling</a>. There is an absence of professionals to support women, no community to take care of them, and lack of a culture that understands, values and protects breastfeeding and breastfeeding mothers whether they are at home, work or out in public. </p>
<p>But instead of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12496">investing in the research, staffing, education and protection</a> that is needed, <a href="https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts">cuts are being made to services</a>, and a bottle of formula is suddenly given as the solution to any <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">breastfeeding challenge</a>. Although formula is sometimes needed when breastfeeding really does not go to plan, the <a href="https://www.nice.org.uk/guidance/ng75">National Institute of Clinical Excellence</a> states that women who want to breastfeed should be given intensive support to increase their milk supply if necessary, before formula is offered. </p>
<p>Moreover, formula doesn’t solve the perceived issues that it is often presented as solving. It <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2014.0153">won’t help a baby sleep</a> at night, does not create a more “settled baby” and does not stop babies wanting to be held. These are normal baby behaviours, <a href="https://www.sciencedirect.com/science/article/pii/S0022347679805405">to help a them feel safe</a> and comforted, and often nothing to do with hunger. And, most importantly, simply telling a mother who wants to breastfeed to give formula rather than helping her work through any challenges will not make her any happier – in fact, as shown, the opposite is often true. Mothers who are let down in this way – <a href="https://www.huffingtonpost.com/jennifer-grayson/there-are-no-tests-the-st_b_11307426.html">often without answers</a> as to why their breastfeeding experience went – wrong blame themselves, stating that they <a href="https://www.sciencedirect.com/science/article/pii/S0277953607003590">feel like failures</a>. </p>
<p>Mothers who cannot breastfeed are absolutely not failing, rather, they are being failed – by a government who is far too quick to promote breastfeeding without protecting it.</p><img src="https://counter.theconversation.com/content/103788/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the 'The Positive Breastfeeding Book'.</span></em></p>Mothers who cannot breastfeed are absolutely not failing, rather, they are being failed.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/981632018-07-03T20:10:45Z2018-07-03T20:10:45ZThe dos and don'ts of supporting women after a miscarriage<figure><img src="https://images.theconversation.com/files/225872/original/file-20180703-116147-16ay5hk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our cultural discomfort with discussing any sort of loss means women are often met with a wall of silence.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/0VFPFbhuyeY">Hermes Rivera</a></span></figcaption></figure><p>So your friend decides to forget the “12 week rule” and tells her family and social networks she is pregnant. She knows the stats – <a href="http://www.sands.org.au/miscarriage">one in four pregnancies</a> ends in miscarriage – but she wants to have the support of family and friends around her in case she needs it. </p>
<p>Then the worst happens: she miscarries. And she discovers many people around her, including health professionals, lack sensitivity when talking about the miscarriage. Some don’t even acknowledge her loss. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/families-that-experience-pregnancy-loss-deserve-higher-standards-of-care-85345">Families that experience pregnancy loss deserve higher standards of care</a>
</strong>
</em>
</p>
<hr>
<p>Miscarriage in Australia is defined as the loss of a foetus before 20 weeks. From a medical perspective, miscarriage is easily managed as a “routine pregnancy complication”. Emotionally, however, it can take a massive toll. As one interviewee in our yet-to-be-published research explained: </p>
<blockquote>
<p>Just because it’s common, doesn’t mean that it’s not extremely traumatic. (Ella) </p>
</blockquote>
<p>Women who experience miscarriage frequently feel grief and loss of a <a href="http://www.apsfa.org/docs/Grief%20Following%20Miscarriage%20A%20Comprehensive%20Review%20of%20the%20Literature.pdf">similar intensity to other major losses</a>. It’s common to have clinical levels of <a href="https://www.fertstert.org/article/S0015-0282(08)04743-2/pdf">anxiety</a>, <a href="https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1471-0528.2007.01452.x">depression</a> and <a href="https://bmjopen.bmj.com/content/bmjopen/6/11/e011864.full.pdf">post-traumatic stress disorder</a> (PTSD) in the weeks, months or years following a miscarriage.</p>
<p>Family, friends and health professionals play an important role in supporting women affected by miscarriage: what they do or don’t say can have a lasting impact. Yet our cultural discomfort with discussing any sort of loss – especially one that is “unseen” – means women are often met with a wall of silence. </p>
<blockquote>
<p>It’s a bit like postnatal depression….people just don’t talk about it. (Linda)</p>
</blockquote>
<p>So how can we support women better? What do women need from family, friends and health professionals at the time of a miscarriage?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225880/original/file-20180703-116126-g3r796.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Grief can affect women’s mental health in the short and long term.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Yv-WSE1n9nk">Nicolas Lobos</a></span>
</figcaption>
</figure>
<p>While there is <a href="https://search.informit.com.au/documentSummary;dn=406186808261657;res=IELHEA">limited evidence-based research</a>, our yet-to-be-published pilot study of 14 women who had experienced miscarriage found their needs align with advice currently provided by Australia’s pregnancy loss support organisations. Here are the key dos and don'ts:</p>
<h2><strong>Dos</strong></h2>
<p><strong>1) Acknowledge their loss.</strong> While you may worry you will say the wrong thing and upset them further, saying nothing at all is worse. It can make women feel you don’t care or think their loss was insignificant. All you need to say is: “I’m sorry about your miscarriage.”</p>
<blockquote>
<p>…I think it’s better acknowledging it than not, because I guess if you’re not acknowledging it, then it feels like you don’t care. (Ellen)</p>
</blockquote>
<p><strong>2) Listen and let them grieve.</strong> Many women need to talk about their experience. Ask them how they are. Some women find it really helpful to talk about how they are feeling, others may not be ready, but will appreciate you asking. </p>
<blockquote>
<p>Talk to them, listen. Don’t just try to sweep it under the carpet … Give the person the opportunity to grieve, because you have lost a child…. (Jane)</p>
</blockquote>
<p><strong>3) Encourage them to talk to other women who’ve had a miscarriage</strong>. It’s often only when women start to talk about their miscarriage, that they find out others around them have experienced miscarriage too. Knowing they’re not alone and that others understand how they’re feeling can be really helpful. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-ways-to-help-parents-cope-with-the-trauma-of-stillbirth-69622">Five ways to help parents cope with the trauma of stillbirth</a>
</strong>
</em>
</p>
<hr>
<p><strong>4) Offer practical support</strong>. Drop off a meal or help with childcare. Gifts and flowers show you care and are acknowledging their loss. </p>
<p><strong>5) End the silence around miscarriage</strong>. Women want miscarriage talked about more openly so they don’t feel so alone. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225876/original/file-20180703-116143-1fpuyrd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">You don’t have to say much.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/e92L8PwcHD4">Ben White</a></span>
</figcaption>
</figure>
<h2>Don’ts</h2>
<p><strong>1) Avoid clichéd comments</strong>. While well intended, comments such as “it wasn’t meant to be” or “it’s so common” can be hurtful and dismissive of their loss. </p>
<blockquote>
<p>People saying, ‘oh you know, you’ll get pregnant again’ or ‘oh it wasn’t meant to be’. You know, that’s just the worst thing to say. And so many people say stuff like that … (Samantha)</p>
</blockquote>
<p><strong>2) Avoid blaming and offering unsolicited advice</strong>. Be sensitive and empathetic; don’t offer advice that could make a woman feel she is to blame.</p>
<blockquote>
<p>lots of unhelpful, unsolicited advice… it was all about ‘you’re working too hard’, ‘you’re stressing too much’, ‘you’re over-thinking it’. (Amy) </p>
</blockquote>
<p><strong>3) Recognise grief doesn’t have a time limit</strong>. Women’s levels of grief are not contingent on how many weeks pregnant they were – their baby has died. It’s OK for them to work through their grief in their own time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-pregnant-after-a-loss-need-better-support-81238">Women pregnant after a loss need better support</a>
</strong>
</em>
</p>
<hr>
<h2>Where to go for help</h2>
<p>Outside social networks, there are a number of vital pregnancy loss support organisations across Australia which provide information, support and bereavement care to women affected by miscarriage. These include:</p>
<ul>
<li><a href="http://www.sands.org.au/">Sands Australia</a> </li>
<li><a href="http://www.bearsofhope.org.au/">Bears of Hope</a> </li>
<li><a href="https://pinkelephantssupport.com/">The Pink Elephants Support Network</a></li>
</ul>
<p>For further psychological support, Medicare covers up to three pregnancy counselling sessions through referral from a GP. </p>
<p>Improving support for women affected by miscarriage starts by speaking openly about it and letting women know they are not alone in the experience. </p>
<p><em>This article was co-authored by Anita Guyett from Sands Australia, a miscarriage, stillbirth and neonatal death charity.</em></p><img src="https://counter.theconversation.com/content/98163/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jade Bilardi receives funding from a National Health and Medical Research Council Early Career Fellowship, No 1013135. </span></em></p><p class="fine-print"><em><span>Jayashri Kulkarni and Meredith Temple-Smith do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cliched comments like “it wasn’t meant to be” or “don’t worry, you’ll get pregnant” are hurtful and dismissive. Instead, acknowledge their loss, listen and let them grieve.Jade Bilardi, Senior Research Fellow, Central Clinical School, Monash UniversityJayashri Kulkarni, Professor of Psychiatry, Monash UniversityMeredith Temple-Smith, Professor, Department of General Practice, University of Melbourne, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/969352018-05-25T12:34:35Z2018-05-25T12:34:35ZMaternal mental health problems – the impact in numbers<figure><img src="https://images.theconversation.com/files/220158/original/file-20180523-51121-11f2jh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnancy and after can be a turbulent time. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-mother-cuddling-sleeping-baby-daughter-562380682">Shutterstock</a></span></figcaption></figure><p>As many as <a href="https://www.rcog.org.uk/globalassets/documents/patients/information/maternalmental-healthwomens-voices.pdf">one in five</a> women develop a mental health problem during pregnancy or in the first year after the birth of their baby. The distress this causes women and their families, the negative impact on their health and well-being, and the economic costs to individuals, the NHS and the nation are considerable. </p>
<p>Maternal mental health problems can range from anxiety, low mood and depression to psychosis. Depression and anxiety are the <a href="https://www.nice.org.uk/guidance/cg192">most common</a> mental health problems during pregnancy, with around 12% of women experiencing depression and 13% experiencing anxiety at some point; many women will experience both. Depression and anxiety also affect 15-20% of women in the first year after childbirth. </p>
<p>Between <a href="https://www.nice.org.uk/guidance/cg192">one and two in 1,000 women</a> who have given birth are affected by <a href="https://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/postpartumpsychosis.aspx">postpartum psychosis</a>, a serious mental illness. Symptoms vary and can change rapidly. They can include high mood (mania), depression, confusion, hallucinations and delusions. In some of the most extreme cases, there is a risk of suicide – it is <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/reports">estimated that a quarter</a> of all maternal deaths are related to mental health problems. </p>
<p>Some women will have suffered these mental health problems before, but for others, symptoms are new and frightening. Rarer problems include panic disorder, obsessive compulsive disorder and exacerbation of eating disorders. Domestic violence is also now <a href="https://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/postpartumpsychosis.aspx">increasingly recognised</a> as a risk factor for perinatal depression, anxiety and post-traumatic stress disorder (PTSD).</p>
<p>The impact of maternal mental health problems goes further. The symptoms may lead to poor bonding with the baby and difficulties with breastfeeding (which can itself lead to distress, anxiety and low mood). Maternal depression can have far reaching consequences on the development of the baby, with problems extending into childhood and adolescence. Research <a href="https://www.nct.org.uk/sites/default/files/related_documents/Tsivos%20et%20al.%20Postnatal%20depression%2016-20.pdf">has shown</a> potential impacts on cognitive development, including language development, conduct and school performance.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675190/">One in eight partners</a> also report <a href="https://www.bbc.co.uk/bbcthree/article/68d922ef-b69f-4ee2-b26d-e60e4b03727b">mental health problems</a> and describe a lack of support. Paternal mental health problems <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-7610.2008.02000.x">can also</a> impact <a href="http://pediatrics.aappublications.org/content/135/2/e339">negatively</a> on child development.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/postnatal-depression-men-get-it-too-87567">Postnatal depression: men get it too</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/220160/original/file-20180523-51141-1d6x0n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/220160/original/file-20180523-51141-1d6x0n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/220160/original/file-20180523-51141-1d6x0n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/220160/original/file-20180523-51141-1d6x0n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/220160/original/file-20180523-51141-1d6x0n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/220160/original/file-20180523-51141-1d6x0n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/220160/original/file-20180523-51141-1d6x0n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Depression has an impact on the whole family.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/couple-woman-suffering-post-natal-depression-173523560?src=yELW42CedTCGwqgSvvuP-g-1-0">Shutterstock</a></span>
</figcaption>
</figure>
<p>Maternal mental health problems <a href="https://www.centreformentalhealth.org.uk/maternal-mental-health">are estimated</a> to cost the UK £8.1 billion each year. A <a href="https://www.iser.essex.ac.uk/research/publications/working-papers/iser/2018-01">recent working paper</a> also suggested that postnatal depression can still have a direct effect on maternal employment five years after birth – even when the effects of low mood are no longer present. </p>
<p>Is help readily available? The short answer is no. It has <a href="https://www.nct.org.uk/sites/default/files/related_documents/Tsivos%20et%20al.%20Postnatal%20depression%2016-20.pdf">been suggested</a> that only 7% of women who experienced mental health symptoms were referred to specialist mental health care. Yet when mental health problems are diagnosed early, these effects can be mitigated. </p>
<p>A woman comes into contact with midwives, health visitors, general practitioners and obstetricians during the course of her pregnancy. It is vital that all of these health care professionals are alert to the possibility of problems and are aware of how common they are. Health care professionals need to enquire about mood at every contact, and refer the women for <a href="http://everyonesbusiness.org.uk/?page_id=349">psychological support</a> as early as possible. And women should feel supported by their health care professional to talk openly about their feelings. Support also needs to be available for partners, as part of a wider approach of treating maternal mental health and limiting the impact it has on the whole family.</p>
<h2>A look ahead</h2>
<p>Fortunately, the situation and awareness of the condition is getting better thanks in part to the many women who are <a href="http://www.bbc.co.uk/news/stories-43979225">sharing their stories</a> and ask for help. </p>
<p>The Royal College of General Practitioners <a href="http://www.rcgp.org.uk/clinical-and-research/resources/toolkits/perinatal-mental-health-toolkit.aspx">developed a toolkit</a> that offers resources for GPs to facilitate the identification and management of maternal mental health problems. This toolkit also includes resources that the GP can signpost the mother and her partner to. <a href="https://www.rcm.org.uk/news-views-and-analysis/news/perinatal-mental-health-the-way-forward">A report</a> from the Royal College of Midwives highlighted the stigma around disclosing mental health problems. This stigma must be broken down – and facilitating women to raise mood problems is a vital part of this.</p>
<p>Following the publication of The Five Year Forward View for Mental Health report, NHS England <a href="https://www.england.nhs.uk/mental-health/adults/">committed to £365m</a> in extra funding to increase access to specialised perinatal mental health support, so that by 2020-21 an additional 30,000 women will be able to receive local specialised treatment. </p>
<p>For all health care professionals supporting women who are pregnant, giving birth or in early motherhood, the aim should be that all women who feel unwell or have concerns about their mood can feel confident telling a health care professional how they feel, and know that they will get the support they need.</p><img src="https://counter.theconversation.com/content/96935/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Chew-Graham is chief investigator on two studies investigating perinatal anxiety. She is a member of the NICE Depression (update) Guideline Development Group.</span></em></p>Here’s how common it is to develop mental health problems in pregnancy or in the first year after birth.Carolyn Chew-Graham, Professor of General Practice Research, Director of Clinical Academic Training, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/875672017-11-20T14:55:26Z2017-11-20T14:55:26ZPostnatal depression: men get it too<figure><img src="https://images.theconversation.com/files/195309/original/file-20171119-11454-19vuqwm.jpg?ixlib=rb-1.1.0&rect=0%2C379%2C5760%2C3311&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/682828864?src=xQo83GVWX7g5wGA_HY9ZFg-1-0&size=huge_jpg">Antonio Guillem/Shutterstock</a></span></figcaption></figure><p>Over the past few years, there has been an increase in media reports about postnatal depression and other maternal mental illnesses, and campaigns have led to greater understanding about the need for more specialist services. Although this is encouraging, very little is said about fathers. But men can get postnatal depression, too.</p>
<p>Currently, only mothers can be diagnosed with postnatal depression. The psychiatrists’ “bible”, the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">Diagnostic and Statistical Manual of Mental Disorders (DSM-5)</a>, includes a diagnosis of “peripartum depression”. Peripartum depression is a form of clinical depression that is present at any time during pregnancy, or within the four weeks after giving birth, although experts working in perinatal mental health tend to be more flexible, extending that period to the first year after giving birth. </p>
<p>In many ways, postnatal depression varies little from traditional depression. It, too, includes a period of at least two weeks where the person experiences low mood or a lack of motivation, or both. Other symptoms include poor sleep, agitation, weight changes, guilt, feelings of worthlessness, and thoughts of death and dying. But the biggest difference is that a depression at this time involves a significant additional person: the child. </p>
<p>Evidence suggests that the long-term consequences of postnatal depression on the child can be damaging, including <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.1996.tb01871.x/abstract;jsessionid=F4C1DF2A61E537190E3CA659EF74EF41.f03t02">developmental problems, poor social interaction</a>, <a href="http://online.liebertpub.com/doi/abs/10.1089/jwh.2008.1050">partner-relationship problems</a> and <a href="http://everyonesbusiness.org.uk/wp-content/uploads/2014/12/Embargoed-20th-Oct-Final-Economic-Report-costs-of-perinatal-mental-health-problems.pdf">greater use of health services (including mental health services)</a>. </p>
<p>Around 7-20% of new mothers <a href="http://onlinelibrary.wiley.com/doi/10.1002/jclp.20644/epdf">experience postnatal depression</a>. A common view is that it is caused by hormonal changes. Although this is partly true, it is far more likely that <a href="http://onlinelibrary.wiley.com/doi/10.1002/jclp.20644/abstract">life factors are responsible</a>, such as poverty, being younger, lack of support and birth trauma. Another potential cause is the sudden overwhelming responsibility of having a baby to care for, and the life changes that it entails.</p>
<p>Depressed mothers also feel intensely guilty about the way they feel about their baby, and fear shame and stigma from society. As a result, at least <a href="https://link.springer.com/article/10.1007%2Fs00737-017-0767-0">50% of mothers</a> will not report a mental health problem. Other mothers will not tell their health provider out of fear of having their child taken away by social services. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195429/original/file-20171120-18574-lmi2ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195429/original/file-20171120-18574-lmi2ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195429/original/file-20171120-18574-lmi2ij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195429/original/file-20171120-18574-lmi2ij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195429/original/file-20171120-18574-lmi2ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195429/original/file-20171120-18574-lmi2ij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195429/original/file-20171120-18574-lmi2ij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Prevalence of postnatal depression in men could be as high as 10%.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/504159763?src=aqcikNPVV-nS8vUh-bFeAA-1-74&size=huge_jpg">Pushish Images/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Mounting evidence</h2>
<p>All of the above factors can equally apply to fathers. But there is no formal diagnosis of postnatal depression for fathers. Yet evidence from several countries, including <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2005.00708.x/abstract;jsessionid=22398CA428A1F2EEC3FB3699ED02C594.f03t03">Brazil</a>, the <a href="http://pediatrics.aappublications.org/content/118/2/659.long?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token">US</a> and the <a href="http://www.sciencedirect.com/science/article/pii/S0140673605667785?via%3Dihub">UK</a>, suggests that around 4-5% of fathers experience significant depressive symptoms after their child is born. Some other studies claim that prevalence may be <a href="https://jamanetwork.com/journals/jama/article-abstract/185905">as high as 10%</a>. </p>
<p>The cause of these feelings in fathers is similar to what we see with mothers, but there are extra complications. Men are much less likely to seek help for mental health problems, generally. </p>
<p>Societal norms in many nations suggest men should suppress emotion. This is probably even more a factor for fathers, who may perceive their role as being practical and providing for the family. Fathers – especially first-time fathers – might experience many sudden changes, including significant reduction in family income and altered relationships with their wife or partner. These are major risk factors for depression in fathers. </p>
<p>The importance for supporting fathers at this time is as vital as it is for mother. Evidence suggests that a father’s depression can have a <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2008.02000.x/abstract">damaging effect</a> on their child’s development. Despite this, it has been shown that fathers are also <a href="http://psycnet.apa.org/record/2003-02034-001">less likely than mothers</a> to seek help, and that <a href="https://gupea.ub.gu.se/bitstream/2077/32509/1/gupea_2077_32509_1.pdf">health professionals</a> are less likely to consider that fathers need support, compared with mothers. More evidence is needed to build a case that fathers need support as much as mothers. </p>
<h2>Poorly equipped</h2>
<p>It has been argued that, until recently, health professionals have been poorly equipped to recognise and treat mental illnesses associated with the birth of a child. Recent campaigns in the UK have led to changes in policy, funding and <a href="https://www.nice.org.uk/guidance/cg192">health guidelines</a>. However, the recent revision of the National Institute for Health and Care Excellence (NICE) guideline on perinatal mental health does not address fathers’ needs. <a href="http://www.bbc.co.uk/news/uk-wales-41726067">Despite a campaign to address this</a> having support from several professionals and academics, a NICE spokesperson told the BBC that guidelines are unlikely to be changed as there is no evidence that men experience postnatal depression. However, if we discount hormonal factors in new mothers, the remaining risk factors for postnatal depression also apply to fathers. And we need support that recognises that.</p><img src="https://counter.theconversation.com/content/87567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Mayers is a member of the Liberal Democrats party in the UK </span></em></p>Postnatal depression in men is starting to be recognised, but mental health services aren’t geared up to help this group.Andrew Mayers, Principal Academic in Psychology, Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/735572017-03-08T09:19:45Z2017-03-08T09:19:45ZDelivering better maternal mental health care: a diagnosis<figure><img src="https://images.theconversation.com/files/158948/original/image-20170301-5492-1d9cxo3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Getting support.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/loving-hands-mothers-hand-holding-her-127196099?src=ols-XsdKc7vVysHzPM3Rsw-1-22">Shutterstock</a></span></figcaption></figure><p>Low mood and anxiety are something we all experience at various points in our lives. And the enormous changes that occur on becoming a new parent means it is a time when these symptoms are particularly common. Dealing with these issues is an important part of caring for new mothers and mothers-to-be. But we need to be wary of turning normal human emotions and experiences into medical diagnoses. </p>
<p>A staggering 81% of women who responded to a <a href="https://www.rcog.org.uk/globalassets/documents/patients/information/maternalmental-healthwomens-voices.pdf">survey</a> by the <a href="https://www.rcog.org.uk/en/">Royal College of Obstetricians and Gynaecologists</a> (RCOG) said they had experienced a maternal mental health problem. This high figure however was widely <a href="https://www.channel4.com/news/concerns-about-womens-mental-health">reported in the media</a> – but it is misleading. As the authors themselves recognised, the self-selecting nature of the survey meant that women with experiences of perinatal mental health problems were far more likely to respond.</p>
<p>There are dangers in reporting such high rates of mental health problems associated with childbirth, or in suggesting that a majority of women need the input of mental health services. An unintended consequence of such high figures is to deflect attention from those women who do require specialist care. It is vital to remember that perinatal mental illnesses, such as <a href="http://www.app-network.org">postpartum psychosis</a>, can be some of the most severe episodes dealt with by mental health services.</p>
<p>We walk a tightrope here though. Because nor should we explain away distressing mental health symptoms as common, expected and what most women experience. The survey found that some women felt their symptoms were not being taken seriously and that they were told it was normal to feel down after having a baby. A related issue is that many women who experienced anxiety or other conditions felt that their symptoms were ignored or not treated seriously enough because they did not fit into the category of postnatal depression (PND). There are many and varied mental health conditions that can occur in pregnancy and the postpartum period – and there are dangers if all are labelled under the catch all category of PND. </p>
<p>But there are positive aspects to the report’s publication. First, whatever the content, the fact that it has come from the Royal College of Obstetricians and Gynaecologists is in itself important and encouraging. As highlighted by the <a href="http://maternalmentalhealthalliance.org/">Maternal Mental Health Alliance</a> campaign, this issue is “<a href="http://everyonesbusiness.org.uk">everyone’s business</a>”. </p>
<p>Although specialist perinatal mental health teams are vital, the mental health of mothers should not be the concern of psychiatric services alone. All health care professionals who come into contact with women in the perinatal period should address both their mental and physical health. Although 85% of women reported that they were asked about their mental health, some felt that through pregnancy and the postpartum only their physical symptoms were assessed and treated.</p>
<p>In maternity services we see no better illustration of the need for “<a href="https://www.rcpsych.ac.uk/pdf/Parity%20of%20Esteem%20briefing%20Feb%202012.pdf">parity of esteem</a>” between mental and physical health. As a society we rightly spend large amounts of time and money ensuring the physical health of mothers and their babies. By comparison, we devote a tiny fraction of this effort and expense to a woman’s mental health. It is incredible that women in around half the UK (including most of Scotland, Wales and Northern Ireland and many parts of England) <a href="http://everyonesbusiness.org.uk/?page_id=349%5D">still have no access</a> to specialist perinatal community mental health teams.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=292&fit=crop&dpr=1 600w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=292&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=292&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=367&fit=crop&dpr=1 754w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=367&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=367&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Little bundles of mixed emotions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-cute-babies-on-light-background-334090796?src=BZawPy5WReyvchvht8BBrg-2-26">Shutterstock</a></span>
</figcaption>
</figure>
<p>Secondly, through this survey we hear from those with personal experience of perinatal mental illness. Theirs is a powerful voice. It is clear to me, having researched and worked in this area for many years, that those in power do not only want to hear from clinicians and academics (if indeed they want to hear from us at all). The individual stories of those who have experienced perinatal mental illness give a human face to the messages emerging from research. The success of the “<a href="http://everyonesbusiness.org.uk">everyone’s business</a>” campaign has in no small part been due to putting the voice of women and their partners front and centre.</p>
<h2>A mother’s work</h2>
<p>Third, there are a number of very clear and important messages from the women who participated. For example, of the women who reported mental health problems it is a concern that the majority were not referred on to services or given any advice about organisations to contact for further help. More disturbingly perhaps, among women who had pre-existing mental health problems, many reported no consensus from health care professionals on whether to stop, reduce, change or continue with medication, with some describing open disagreements within the health care team. </p>
<p>Although there are undoubtedly examples of world leading perinatal mental health care in the UK, the survey revealed an unacceptably wide variation, with little evidence of the universal delivery of evidence based care on the basis of need rather than postcode. </p>
<p>We know the need. We know what to do – and it is clear that this issue does not benefit from a “one size fits all” approach. We need universal and specialist services that enable the right level of support and treatment to be delivered to the right woman at the right time – no matter what her mental health condition or where she lives. With extra funding for perinatal mental health services being delivered in some parts of the UK we are moving in the right direction. There clearly remains, however, some distance to go.</p><img src="https://counter.theconversation.com/content/73557/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Jones is a Profeesor of psychiatry at Cardiff university and a perinatal psychiatrist
He is Director of the National Centre for Mental Health (NCMH)
He is a trustee and past Chair of Action on Postpartum Psychosis
He is affiliated with the Maternal Mental Health Alliance and Chairs the Campaign Working Group of the Comic Relief funded Everyone,s Business Campaign </span></em></p>Many women are not getting the right kind of attention.Ian Jones, Professor of Psychiatry, Director of National Centre for Mental Health, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/690512017-02-08T03:43:45Z2017-02-08T03:43:45ZWe’ve all heard about postnatal depression, but what about antenatal depression?<figure><img src="https://images.theconversation.com/files/154510/original/image-20170127-30397-i1op62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The belief that all women feel nervous during pregnancy may mean women don't seek help when it's more serious. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>We all know and hear a lot about postnatal depression, but what about depression and anxiety during pregnancy?</p>
<p>Over the past two decades, most research on mothers’ mental health has focused on the time after childbirth. Only recently has attention turned to the issue of maternal mental health during pregnancy. </p>
<p>Our <a href="https://www.ncbi.nlm.nih.gov/pubmed/19036042">study</a> involving 1500 first-time mothers suggests around one in ten mothers have clinically significant depressive symptoms in the first three months of pregnancy, and a similar proportion have severe anxiety symptoms.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/17978126">Other studies measuring symptoms</a> at later stages of pregnancy, or over a number of time points, indicate even higher proportions of women have clinically significant depressive and/or anxiety symptoms during pregnancy.</p>
<p>Women who have depressive symptoms during pregnancy are also much more likely to have anxiety or depression after childbirth. Although it’s important to point out not all women who have these symptoms during pregnancy go on to have mental health problems after their baby is born.</p>
<h2>So what is antenatal depression?</h2>
<p>Pregnancy can be an unsettling time for women and men. It’s common for women to feel overwhelmed by the extreme fatigue, and physical and emotional changes associated with pregnancy. </p>
<p>There are many ways symptoms of depression and anxiety can manifest. Some women have difficulty making decisions or managing everyday tasks. Others become extremely anxious and may have panic attacks. Others feel numb and may not want to see family or friends. </p>
<p>All pregnancies are a “journey into the unknown”. Most women and men will experience some anxiety as a normal part of getting ready to welcome a new baby. While some anxiety is normal, debilitating anxiety is not. </p>
<h2>What can cause antenatal depression?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/154511/original/image-20170127-30401-1yixl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/154511/original/image-20170127-30401-1yixl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/154511/original/image-20170127-30401-1yixl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/154511/original/image-20170127-30401-1yixl9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/154511/original/image-20170127-30401-1yixl9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/154511/original/image-20170127-30401-1yixl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/154511/original/image-20170127-30401-1yixl9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/154511/original/image-20170127-30401-1yixl9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The causes of depression and anxiety during pregnancy do not differ much from the causes at other times.</span>
<span class="attribution"><span class="source">from www.ahutterstock.com</span></span>
</figcaption>
</figure>
<p>The causes of depression and anxiety during pregnancy do not differ much from the causes at other times. Common causes are lack of social support, financial stress, relationship difficulties and stressful life events, such as moving house, or something bad happening to a close family member or friend.</p>
<p>Factors specific to pregnancy include: unintended or poorly timed pregnancy, and pregnancy complications such as severe morning sickness, a history of miscarriage or preterm birth. </p>
<p><a href="https://www.mcri.edu.au/sites/default/files/media/documents/research_themes_and_groups/mhs_policy_brief_no_2.pdf">Victorian research</a> shows one in five women experience emotional and/or physical abuse by an intimate partner in the first 12 months after giving birth; a similar proportion are afraid of their partner during pregnancy. This translates to 14,000 Victorian families a year affected by family violence during pregnancy and in their child’s first year of life. </p>
<p>Women who are afraid of their partner during pregnancy are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19036042">markedly more likely</a> to have antenatal anxiety and depression. They are also more likely to have other adverse outcomes, such as bleeding during pregnancy, preterm birth, low infant birthweight or stillbirth.</p>
<h2>Why it may be hard for women to seek help</h2>
<p>Pregnancy is a time when women have a lot of contact with health services. <a href="http://www.health.gov.au/antenatal">Australian guidelines recommend</a> a minimum of ten visits to a health professional for women having their first baby, and at least seven visits for women having their second or a subsequent baby. Despite this frequent contact, many women experiencing depression and anxiety during pregnancy do not disclose this to health professionals. </p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/19214705">reasons</a> vary. Women may be reluctant to talk about their symptoms because they feel embarrassed about seeking help, or may not feel confident to talk to a health professional about what they’re experiencing. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/19214705">Our research</a> with first-time mothers shows women are more comfortable talking about depressive symptoms than anxiety. In part, this may reflect the greater media attention given to postnatal depression. </p>
<p>Some women taking part in our research regarded their symptoms as “normal”, “to be expected” or “not severe enough” for them to seek professional help. Women may tend to minimise psychological problems in the context of motherhood. They may also fear their capacity to care for their child may be questioned.</p>
<h2>Getting it right in the first 1000 days</h2>
<p>The first 1000 days – the period from conception to age two – is recognised as the time when foundations are laid for health across the lifespan. If we don’t get it right in this period, there are lifelong costs to individuals, families and communities. </p>
<p>The <a href="http://www.who.int/reproductivehealth/publications/violence/9789241548595/en/">World Health Organization</a> recommends routine screening during pregnancy to identify women experiencing or at risk of experiencing emotional or physical abuse.</p>
<p>The good news is there’s a window of opportunity in the first 1000 days to do things to support women and families that can have long-term effects on the health and well-being of future generations of Australian children. </p>
<p>The clustering of risk (child and adult experiences of abuse) and accumulation of risk factors within families (family violence and other stressful events, such as financial hardship, combined with poor mental health) means some women and children may need more intensive responses. </p>
<p>For other women, anxiety and depression during pregnancy may occur for other reasons, and require different responses. Tailoring support to suit women’s circumstances is crucial to improving maternal and child health outcomes in the longer term.</p>
<hr>
<p><em>Anyone at risk of family and domestic violence and/or sexual assault can seek help 24 hours a day, seven days a week, either <a href="https://www.1800respect.org.au/">online</a> or by calling 1800 RESPECT (1800 737 732). Information is also available in 28 languages other than English.</em></p>
<p><em>If this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 14 or beyondblue on 1300 22 4636.</em></p>
<p><em>Parenting advice and resources are available from the <a href="http://raisingchildren.net.au/">Raising Children Network</a>.</em></p><img src="https://counter.theconversation.com/content/69051/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Brown receives funding from the National Health and Medical Research Council. </span></em></p>Depression and anxiety during pregnancy are only recently gaining attention. But seeking help early can make a big difference for expecting mothers – and for their children and families.Stephanie Brown, Senior Principal Research Fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/625452016-07-18T20:06:30Z2016-07-18T20:06:30ZMums and dads of very preterm babies more likely to be depressed<p>The classic image of a newborn baby happily nestled in the proud parents’ arms is one we are all familiar with. Many of us are lucky enough to have one on the mantelpiece, but some families miss out on taking this photo. </p>
<p>Babies who come too early, often weighing under a kilogram, are rushed away from their parents to the neonatal intensive care nursery in a fight for survival. Babies are classified as preterm when they are born <a href="http://www.who.int/mediacentre/factsheets/fs363/en/">prior to 37 weeks’ gestation</a>. </p>
<p>Within this group, those born prior to 32 weeks are classified as very preterm. In Australia, more than <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129545698">5,000 babies</a> are born very preterm every year, and it is these babies who are at greatest risk for a <a href="http://www.ncbi.nlm.nih.gov/pubmed/12824207">wide range of adverse outcomes</a>. </p>
<p>A new baby is life-changing for all parents, but for those whose babies are born too early, the challenges can be immense. </p>
<p>Our research <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=2532578">published today in JAMA Pediatrics</a> reports concerning levels of psychological distress in both mothers and fathers of very preterm babies. We closely followed these families, assessing parental mental health every two weeks for the first 12 weeks after birth, then again six months later. </p>
<p>In the weeks immediately following the birth of their babies, 40% of mothers and 36% of fathers experienced clinically significant symptoms of depression. This was compared to just 6% of mothers and 5% of fathers of healthy full-term babies.</p>
<p>Rates of anxiety were even higher, at close to half of both mothers and fathers. Thankfully, symptoms improved over the course of the first 12 weeks. When we checked in again with parents six months later, though, 14% of mothers and 19% of fathers were still distressed, compared to 5% of mothers and 6% of fathers of full-term babies. </p>
<p>There was little evidence changes in parental psychological distress were related to medical severity, time of transfer or discharge from hospital, or other family factors. </p>
<p>In many ways, it’s not surprising parents of very preterm infants are at far higher risk of depression and anxiety than parents of healthy, full-term babies. Their experiences are vastly different. </p>
<p>Parents of very preterm babies often describe great fear, shock, feelings of helplessness and unmet expectations, as well as inherent separation from their babies. </p>
<p>On average, the very preterm babies in our study stayed in hospital for about three months – a far cry from the few days following a straightforward birth. A baby’s path through the neonatal intensive care unit is often not smooth, which puts enormous strain on families in a multitude of ways. </p>
<p>There is also the impact of grief – many parents speak of the sense of loss they feel for the pregnancy, the birth and the baby they had imagined. </p>
<h2>Father’s depression often neglected</h2>
<p>Fathers of very preterm babies have been largely neglected in the research to date. This study is the first to our knowledge to look at the mental health of fathers in this way. </p>
<p>We found they were no less susceptible to depression and anxiety than mothers. This differs from rates reported in the general population, which show that <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0">men have lower rates of depression and anxiety than women</a>, regardless of whether they are <a href="http://www.ncbi.nlm.nih.gov/pubmed/20483973">fathers</a> or not.</p>
<p>There are a few potential reasons for this new finding. First, there is no doubt the neonatal intensive care unit experience can be highly stressful for both mothers and fathers. </p>
<p>However, it is important to appreciate that fathers also often have unique pressures. Many men described feeling torn between their partner and their baby, both in need of extra support. They were often going back to work and juggling multiple responsibilities, especially when there are other children at home. </p>
<p>Many also spoke of the challenges of trying to meaningfully engage in an environment where traditionally the focus is on mothers. </p>
<h2>What can be done?</h2>
<p>It’s important for parents to know that, for many people, the distress they feel after having a preterm baby does improve over the first few months. This may represent a period of adjustment. </p>
<p>However, as parents in our study were still showing higher rates than their full-term counterparts six months later, it is also important to be aware the challenges for these families do not end when they leave hospital. </p>
<p>We know from previous research mothers still have higher rates of psychological distress <a href="http://www.ncbi.nlm.nih.gov/pubmed/19955253">two</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24359937">seven</a> years after having a very preterm baby. </p>
<p>It’s important health professionals working with these families closely monitor parents for signs of depression and anxiety at regular intervals during the hospital stay and beyond, and ensure they are receiving appropriate support. This support needs to continue far beyond the traditional postnatal period. </p>
<p>It’s clear we need to be more aware of the well-being of fathers. Many of our fathers said they were surprised we were interested in how they were going, and were grateful for it. </p>
<p>This article talks about the typical nuclear family consisting of a mother and father, but of course there is also much diversity in families. This extra awareness and support must apply to all caregivers and support people involved in the birth of a child. </p>
<p>All parents sometimes need reminding to look after themselves. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/21052833">large body of research</a> shows parental mental health is important for child outcomes. Parents of very preterm babies getting the support they need will not only improve their own well-being, but will go a long way to help protect these vulnerable babies too.</p>
<hr>
<p><em>Further information and support for parents of preterm babies can be found at <a href="https://www.lifeslittletreasures.org.au">Life’s Little Treasures</a> or <a href="http://raisingchildren.net.au/premature_babies/premature_babies.html">Raising Children Network</a>.</em></p>
<p><em>For general support you can contact <a href="https://www.lifeline.org.au">Lifeline</a>: 131 114 or <a href="https://www.beyondblue.org.au">Beyond Blue</a>: 1300 22 4636</em></p><img src="https://counter.theconversation.com/content/62545/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carmen Pace does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new baby is life-changing for all parents, but for those whose babies are born too early, the challenges can be immense.Carmen Pace, Clinical Psychologist and Research Fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/558292016-05-01T19:54:59Z2016-05-01T19:54:59ZDads get postnatal depression too<figure><img src="https://images.theconversation.com/files/118857/original/image-20160415-11469-mru627.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most people think only women get postnatal depression.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/XdSKsM2gbeM">James Garcia/upsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This is the second article in our series on men’s hidden health conditions. Read <a href="http://theconversation.com/men-more-reluctant-to-go-to-the-doctor-and-its-putting-them-at-risk-57420">today’s article</a> on why men are more reluctant to go to the doctor.</em></p>
<hr>
<p>It will come as no surprise that some new fathers will be anxious or highly stressed. However, most people believe only new mums suffer postnatal depression. This is not the case.</p>
<p>The rate of depression for dads is less than that for mums but our best estimate is that about <a href="http://jama.jamanetwork.com/article.aspx?articleid=185905">one in ten</a> dads will be affected. If there is a birth somewhere in Australia every 1 minute 46 seconds, then every day about <a href="http://www.abs.gov.au/ausstats/abs%40.nsf/94713ad445ff1425ca25682000192af2/1647509ef7e25faaca2568a900154b63?OpenDocument">80 dads</a> are being added to the depressed category.</p>
<p>The silence from government is puzzling, as paternal depression is expensive. <a href="http://www.panda.org.au/images/stories/PDFs/PANDA_Exec_Summ_Deloitte_Web.pdf">Figures from 2012</a> show that health-care costs for new fathers’ depression totalled A$17.97 million and the economy lost A$223.75 million in productivity.</p>
<p>There are flow-on effects at home too. Feeling down and being grumpy is not the best way to start your fathering. <a href="http://pediatrics.aappublications.org/content/127/4/612.short">Depressed dads in the US</a> were four times more likely to hit their one-year-old babies and less than half as likely to read to them. </p>
<p>In the long run the effects of a having a miserable father are dramatic. <a href="http://www.sciencedirect.com/science/article/pii/S0140673609602385">Studies</a> following infants through childhood show a child of a depressed father has three times the rate of behaviour problems and twice the chance of a psychiatric diagnosis at seven years of age.</p>
<p>Sad dads affect mums too. Lack of partner support is a <a href="http://www.ncbi.nlm.nih.gov/pubmed/22878534">major risk factor</a> for mothers developing depression. And it can make it harder for her to recover if she does feel down.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/120633/original/image-20160429-16230-lrnz22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/120633/original/image-20160429-16230-lrnz22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/120633/original/image-20160429-16230-lrnz22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120633/original/image-20160429-16230-lrnz22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120633/original/image-20160429-16230-lrnz22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120633/original/image-20160429-16230-lrnz22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120633/original/image-20160429-16230-lrnz22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120633/original/image-20160429-16230-lrnz22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A new life is a big change for dads as well as mums.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Why don’t we hear about it?</h2>
<p>The simplest answer as to why we don’t hear more about paternal depression is that dads don’t talk about it. Some 40% of 1,500 fathers <a href="https://www.beyondblue.org.au/about-us/research-projects/research-projects/dads-research">surveyed by beyondblue</a> did not seek help even when stressed.</p>
<p>This may not simply be because the men saw depression and anxiety as a sign of weakness, which was a theme in the focus group results. The connection between mothers and depression may be so strong that it blinds men to the notion that they could be more than just stressed. The survey also found that 45% did not know that fathers could get postnatal depression. </p>
<p>As <a href="https://www.beyondblue.org.au/about-us/research-projects/research-projects/dads-research">one dad</a> described why he wouldn’t look for help with postnatal depression on the BeyondBlue website:</p>
<blockquote>
<p>With all due respect, it’s the women’s section – why would I look there?</p>
</blockquote>
<p>It would be a mistake to focus only on fathers’ wish not to be weak. Mothers also shy away from mental illness labels and avoid asking for help. For their part, health workers <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495314/">do not have a great strike rate</a> at picking up depression in mums or dads.</p>
<p>For mothers, though, we make an effort. The <a href="https://www.beyondblue.org.au/about-us/about-our-work/perinatal-mental-health">national perinatal depression initiative</a> had all states involved in screening mothers and health staff were trained to improve referrals for mothers. But fathers don’t go for pregnancy check-ups and they have few contacts with health services.</p>
<h2>Asking for help</h2>
<p>We need new ways to connect to fathers. Apps such as <a href="http://www.whosyourdaddyapp.com/#about">Who’s Your Daddy?</a> or <a href="http://www.apple.com/itunes/download/">Daddyo For New Dads</a> offer easy access to information on parenting. <a href="http://www.SMS4dads.com">SMS4dads</a> is testing “checking in” with questions of mood and stress levels with back-up telephone help.</p>
<p>None of these will work without more awareness that a father’s depression has impacts not only on him but on his infants and his partner too.</p>
<hr>
<p><em>* A figure in the article has been amended from eight dads to eighty.</em></p>
<hr>
<p><em>Further reading:</em></p>
<p><em><a href="http://theconversation.com/men-more-reluctant-to-go-to-the-doctor-and-its-putting-them-at-risk-57420">Men more reluctant to go to the doctor – and it’s putting them at risk</a></em></p>
<p><em><a href="https://theconversation.com/au/topics/womens-health-series">Women’s health series</a></em></p><img src="https://counter.theconversation.com/content/55829/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Fletcher receives funding from government and non-government organizations including beyondblue.
Richard Fletcher is convenor of the ARACY Fatherhood Research Network </span></em></p>It will come as no surprise that some new fathers will be anxious or highly stressed. However, most people believe only new mums suffer postnatal depression. This is not the case.Richard Fletcher, Associate professor, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/518082015-12-17T19:35:13Z2015-12-17T19:35:13ZNew mothers making time for themselves reduces chance of postnatal depression<figure><img src="https://images.theconversation.com/files/105203/original/image-20151210-7453-12jd9al.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even just taking a long hot bath, alone, once a week, reduced the risk of postnatal depression.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/aigle_dore/15571695420/">Moyan Brenn/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><a href="http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12837/abstract;jsessionid=9C2CA1DBDE6A8F7B97F62CDA616C3AA3.f03t01?userIsAuthenticated=false&deniedAccessCustomisedMessage=">One in three women</a> will experience significant depressive symptoms in the first five years after giving birth. But <a href="http://onlinelibrary.wiley.com/doi/10.1111/birt.12210/abstract">new research</a> has found if mothers regularly take time for themselves in the first six months after giving birth they’re less likely to get postnatal depression.</p>
<p>In the early months after giving birth, women’s <a href="http://www.midwiferyjournal.com/article/S0266-6138%2813%2900097-1/abstract">physical health</a>, <a href="http://www.tandfonline.com/doi/abs/10.3109/0167482X.2012.720314#.Vm4q8b_GqJ0">intimate relationships</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03219.x/full">mental health</a> are strained. Many new mothers experience mental health problems and they do not improve over time.</p>
<p>In fact, depression is commonly episodic rather than acute (meaning that it is most likely to come and go), and the prevalence of depression <a href="https://www.mcri.edu.au/sites/default/files/media/documents/mhs_policy_brief_1_0.pdf">increases</a> over the first four years after giving birth. </p>
<p>Maternal depression has clear and obvious impacts on women, children and families. Despite the importance of women’s mental health after birth, there has been very limited evidence of effective ways to prevent maternal depression and promote mental well-being at this time. </p>
<h2>Making time</h2>
<p>We studied more than 1,500 women and discovered a strong and robust association between “taking time for themselves, when someone else looks after the baby” at six months after birth and the prevalence of depression symptoms. The prevalence of depressive symptoms steadily decreased as the frequency of time for self increased (see Figure 1). </p>
<p>The lowest prevalence of depression was 6% in women who had time for themselves once a week or more. Compared to women who had personal time at least once a week, women who never had personal time were three times more likely to experience depression in the postnatal period.</p>
<p>Just under half of the women in the study (49%) had regular, weekly personal time. One in six reported they never had personal time when someone else looked after the baby.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/105199/original/image-20151210-7453-12ottgu.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/105199/original/image-20151210-7453-12ottgu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/105199/original/image-20151210-7453-12ottgu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=348&fit=crop&dpr=1 600w, https://images.theconversation.com/files/105199/original/image-20151210-7453-12ottgu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=348&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/105199/original/image-20151210-7453-12ottgu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=348&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/105199/original/image-20151210-7453-12ottgu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/105199/original/image-20151210-7453-12ottgu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/105199/original/image-20151210-7453-12ottgu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure one: prevalence of depressive symptoms at six months postpartum, by frequency of time for self.</span>
<span class="attribution"><span class="source">Author Provided</span></span>
</figcaption>
</figure>
<p>We initially thought the relationship between personal time and depression could be explained by other factors such as relationship status, or general practical and emotional support. There was indeed a strong relationship between measures of social support and how often women had time for themselves. However, even after taking these factors into account, the frequency of time for self significantly predicted maternal depression. </p>
<p>Activities commonly reported by women when they had personal time included: going out with their partner; having a long bath or shower; going to the hairdresser; or putting their feet up and watching TV. The most commonly reported activity was doing the supermarket shopping. While probably not an activity usually associated with relaxation, a lot of new mothers can probably relate to the sense of peace that comes from doing the shopping alone, after having attempted it with a baby. </p>
<p>We suspect that what women actually do when they have time for themselves may not matter so much as that someone else looks after the baby for a while – meaning that women get a break from that responsibility.</p>
<h2>How to make the most of these findings</h2>
<p>Maternal mental health is important because the transition to motherhood can be such a challenging time, but also because maternal depression can have <a href="http://link.springer.com/article/10.1007/s00737-015-0562-8">long-lasting impacts</a> on children. </p>
<p>While a weekly time-out for mothers sounds like a simple fix, it may not be straightforward for all mothers to achieve this. It requires the ongoing support of others – such as partners, family and friends. </p>
<p>These significant others can play an important role in promoting women’s mental health after birth – by encouraging women to take time for themselves, and by taking responsibility for looking after the baby for that time. </p>
<p>Many new mothers feel like they should be able to cope with the demands of caring for a new baby on their own. Therefore, asking for help can be difficult. </p>
<p>We know the majority of childcare responsibilities still fall to women. The more we can share the demands of looking after a new baby between partners and other family members, the healthier mothers will be, and thus healthier children and healthier families.</p><img src="https://counter.theconversation.com/content/51808/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Woolhouse receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Stephanie Brown receives funding from the National Health and Medical Research Council and the Australian Research Council. </span></em></p>Supporting new mothers to make weekly “time for themselves” in the first six months after giving birth may reduce the prevalence of postnatal depression.Hannah Woolhouse, Senior Research Officer, Healthy Mothers Healthy Families, Population Health, Murdoch Children's Research InstituteStephanie Brown, Senior Principal Research Fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/424222015-10-01T20:13:31Z2015-10-01T20:13:31ZChemical messengers: how hormones affect our mood<figure><img src="https://images.theconversation.com/files/95483/original/image-20150921-19274-2bzqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some women are very sensitive to small shifts in hormones, others aren't. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/gagilas/8117584487/">Petras Gagilas/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>“It’s that time of the month – stay away from her!” </p>
<p>The process of shedding the uterine lining with vaginal bleeding every month has an obvious reproductive focus, but it has also long been linked with changes to mood and behaviour. Unfortunately, this has often been an attempt to consign women to a “biologically” determined place of inferior mental functioning.</p>
<p>In recent times, we have learnt more about the connections between the “reproductive” or gonadal hormones and the brain, and how they affect not only women but men as well. </p>
<p>Gonadal hormones (oestrogen, progesterone and testosterone) are produced by the gonads (the ovaries and testes) in response to other precursor hormones found in the pituitary gland and other brain areas. These gonadal hormones impact brain chemistry and circuitry, and hence influence emotions, mood and behaviour. </p>
<h2>Women’s hormones</h2>
<p>Oestrogen appears to be a “protective” agent in the brain. This may in part explain why some women feel worse, in terms of their mental state, in the low-oestrogen phase of their monthly cycle. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=301&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=301&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=301&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=378&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=378&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=378&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A ‘classic’ 28 day cycle – though many women have shorter or longer cycles.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-162580289/stock-vector-menstrual-cycle-hormone-level-average-menstrual-cycle-follicular-phase-ovulation-luteal-phase.html">Tefi/Shutterstock</a></span>
</figcaption>
</figure>
<p>Oestrogen appears to have direct impacts on dopamine and serotonin, the key brain chemicals associated with the development of depression and psychosis. In fact, animal and <a href="http://www.ncbi.nlm.nih.gov/pubmed/18678800">clinical studies</a> show that administering oestradiol (the most potent form of oestrogen) can improve symptoms of psychosis and depression. </p>
<p>The concept of PMS (premenstrual syndrome) has its believers and non-believers. But essentially, there is a group of women who experience significant mental and physical symptoms in the low-oestrogen phase of their cycle every month. </p>
<p>Then there are women with crushing depression once per month that is known as <a href="http://www.med.unc.edu/psych/wmd/mood-disorders/menstrually-related#md_pmdd">premenstrual dysphoric disorder</a> (PMDD). PMDD is a serious, real depression that can rob a woman of her functioning every month. The tricky part is that it’s not always exactly the week before bleeding, nor does it last exactly a week since many women do not have the “classic” 28-day cycle with ovulation at day 14, and bleeding for five days. If life were that simple!</p>
<p>The impact of gonadal hormones on mood is apparent at many other life stages. Around puberty, a time of major hormonal change, many girls experience various mood swings and other changes in mental health. Some women who take certain types of the combined oral contraceptive experience depressive symptoms with irritability, loss of enjoyment and even suicidal thoughts.</p>
<p>Postnatal depression and <a href="http://www.blackdoginstitute.org.au/public/depression/inpregnancypostnatal/postnatalpuerperalpsychosis.cfm">psychosis</a> are key mental illnesses related to childbirth and have a major hormonal component to the onset and course of illness. This is thought to be triggered by the sudden, rapid drop in the high levels of pregnancy hormones shortly after birth.</p>
<p>During the transition to menopause, women experience major hormonal shifts. At this time, they are 14 times more likely than usual to experience depression. This is known as <a href="http://www.med.unc.edu/psych/wmd/mood-disorders/menstrually-related#md_perimen">perimenopausal depression</a>. It affects women differently than other types of depression, causing anger, irritability, poor concentration, memory difficulties, low self-esteem, poor sleep and weight gain.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=612&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=612&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=612&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hormones can influence our moods at different stages of life.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-174361181/stock-photo-happy-together-grandmother-with-her-daughter-and-her-granddaughter-outdoor-in-nature.html?src=bf_Yt7mjBIgcJusVoRA0WQ-1-4">Martin Novak/www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Perimenopausal depression isn’t well recognised and is often poorly treated with standard <a href="https://theconversation.com/some-antidepressants-work-better-than-others-now-we-know-why-17850">antidepressant therapies</a>. Women with this type of depression generally respond better to hormone treatments, but the link between depression and hormones is not often made.</p>
<p>It’s also important to note that trauma and violence can lead to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/">chronically elevated levels</a> of the stress hormone cortisol, causing significant mental ill health at any time in a woman’s life. High cortisol levels have huge impacts on many brain regions, resulting in rage, suicidal thoughts, obesity and infertility.</p>
<p>There is a great deal of variation in the effects of hormone shifts on mood and behaviour. Some women are very sensitive to small shifts in gonadal hormones; others are not. </p>
<h2>Men’s hormones</h2>
<p><a href="http://www.sciencedirect.com/science/journal/10432760/12/10">Recent research</a> investigating cognition in men suggests that, just like in women, gonadal hormones influence mood and behaviour. In particular, low levels of testosterone can lead to an age-related condition called andropause. </p>
<p>Andropause is sometimes described as the “male menopause”. This is not strictly accurate since unlike female fertility, male fertility does not end abruptly with a fixed hormone decline. Andropause is caused by a significant decline in testosterone levels to below the normal range for young men. This <a href="http://www.growthhormoneigfresearch.com/article/S1096-6374(03)00061-3/abstract">can result</a> in erectile problems, diminished libido, decreased muscle strength and decreased bone mass. </p>
<p>To complicate matters, testosterone is converted to oestradiol (the most potent form of oestrogen) in men. Altered testosterone/oestradiol ratios can cause problems with memory function, depression, irritability, sleep, fatigue and occasionally even <a href="http://www.npjournal.org/article/S1555-4155(08)00522-9/abstract">hot flushes</a>.</p>
<p>There is controversy about how much of these changes are a normal part of ageing. Many other factors such as obesity, diabetes and excessive alcohol consumption can also cause low testosterone levels. So andropause should not be viewed as a disease, but as a clinical syndrome with a great deal of variability. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Testosterone levels reduce with age.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-303241304/stock-photo-senior-hands-resting.html?src=GZ9pbd1c2opZCvLnDXfSrg-1-97">carballo/Shutterstock</a></span>
</figcaption>
</figure>
<p>In some men, testosterone-replacement has been used successfully to treat andropause. But this needs to be done under strict medical supervision because of the many potential side effects including prostate problems, elevated cholesterol and increased rage. </p>
<p>A great deal more research is required in both men and women on the role of gonadal hormones and mental health. But the era of splitting the mind from the body should be long gone. </p>
<p><em>This article is part of an occasional series, <a href="https://theconversation.com/au/topics/chemical-messengers">Chemical Messengers</a>, on hormones and the body.</em></p><img src="https://counter.theconversation.com/content/42422/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jayashri Kulkarni receives funding from the NHMRC, ARC, several pharmaceutical companies for clinical trials research. This article is independently written and has no source of funding and no conflict of interest.</span></em></p>In recent times, we have learnt more about the connections between the “reproductive” or gonadal hormones and the brain, and how they affect not only women but men as well.Jayashri Kulkarni, Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/430062015-06-10T23:07:52Z2015-06-10T23:07:52ZPostnatal depression is a continuation of existing mental health problems<figure><img src="https://images.theconversation.com/files/84481/original/image-20150610-6814-bps9dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Two-thirds of mothers who had mental health problems in their teens and 20s also had postnatal depression.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-201555962/stock-photo-mother-with-newborn-baby.html?src=B2RM97YRVzPQxpzu6DPEOQ-1-84">fufu10/Shutterstock</a></span></figcaption></figure><p>Postnatal depression affects around <a href="http://www.mindhealthconnect.org.au/birth-postnatal-depression">one in six</a> mothers. In this sense, it’s the most common complication of pregnancy. </p>
<p>The effects of postnatal depression on children’s emotional development can be profound. These children <a href="http://www.ncbi.nlm.nih.gov/pubmed/22407278">have more</a> mental health and behavioural problems as they grow up. And in low-income countries, the <a href="http://bmb.oxfordjournals.org/content/early/2011/12/02/bmb.ldr047">effects</a> of maternal depression extend to higher rates of childhood stunting and physical illness.</p>
<p>Postnatal depression has always been seen as different to other mental health problems. That thinking dates back to the mid-19th century, when French psychiatrist Louis Victor Marcé published a monograph on the “madness of pregnant women”. He introduced the idea that the postnatal period is one of higher risk for mental health problems. </p>
<p>The idea evolved that postnatal depression was linked to the hormonal changes that accompany pregnancy and childbirth. Women with postnatal depression were not viewed as having higher risks of depression at other times in life.</p>
<p>About 20 years ago that thinking began to shift. We realised that having a mental health problem earlier in life was a risk factor for mental health problems during the perinatal period (throughout pregnancy and after birth). </p>
<p>Our research paper, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62248-0/abstract">published today in the Lancet</a>, shows that, overwhelmingly, perinatal depression is a continuation of mental health problems from earlier in life. This provides one of the most comprehensive pictures of mental health from the second to the fourth decade anywhere in the world. </p>
<h2>Continuation of earlier problems</h2>
<p>The new research draws on a Victorian study that tracked adolescents across 25 years. We contacted 1000 women participants every six months between the ages of 29 and 35, and enrolled 384 women with 564 pregnancies. </p>
<p>To assess the women’s depressive symptoms, we interviewed them by phone at 32 weeks gestation, eight weeks after birth and 12 months after birth, using the Edinburgh Postnatal Depression Scale. </p>
<p>Mental health problems of some kind were very common among these women in their teens and young adult years. Almost <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962116-9/abstract">two-thirds</a> of these female participants had some sort of mental health problem in the 15 years before the study began. </p>
<p>Most (85%) of the women with high levels of perinatal depressive symptoms had a history of mental health problems from before pregnancy. For the great majority, these problems were long standing, across their teens and twenties. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/84482/original/image-20150610-6790-3yuh58.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84482/original/image-20150610-6790-3yuh58.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84482/original/image-20150610-6790-3yuh58.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84482/original/image-20150610-6790-3yuh58.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84482/original/image-20150610-6790-3yuh58.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84482/original/image-20150610-6790-3yuh58.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84482/original/image-20150610-6790-3yuh58.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The window for prevention extends well before pregnancy.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-174265457/stock-photo-students-in-class.html?src=7bH5XvTCJilqOs2grm1K-w-2-121">Areipa.lt/Shutterstock</a></span>
</figcaption>
</figure>
<p>Yet it is not all bad news. Most women with prior mental health problems do not go on to have perinatal depression. For women with a history of problems across both their teens and twenties, the risks were one in three. However, the other two in three did not go on to experience perinatal depression. </p>
<p>For those with no mental health problems before pregnancy, the risks were around one in 12. </p>
<p>So clearly, other factors in these women’s lives – their relationships, their stresses and their emotional resilience – make a big difference.</p>
<h2>Earlier detection and treatment</h2>
<p>Existing responses to maternal depression have focused on identifying women as they become depressed and intervening to provide support, counselling or, in some instances, medication. This has had mixed success. </p>
<p>Given that the window for prevention extends well before pregnancy, we have the option of acting earlier. It makes sense to treat severe and persistent mental health problems well before pregnancy, and to invest in psychotherapy and support for young women contemplating pregnancy. </p>
<p>Australia can be proud of the investments that it has made in promoting child development across the early years of life. Yet the foundations for future parenthood are laid in the teen and young adult years. These are increasingly hazardous for mental health and social adjustment. They are also years where we have <a href="https://theconversation.com/healthy-youth-is-key-to-a-healthy-life-but-australia-remains-behind-28264">failed to develop</a> coherent policies to promote well-being. </p>
<p>If we want the best possible start to life for mothers and children, we need to support and invest in the mental health of young people in the years leading into a first pregnancy – their teens and twenties.</p><img src="https://counter.theconversation.com/content/43006/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>George Patton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Postnatal depression affects around one in six women. In this sense, it’s the most common complication of pregnancy.George Patton, Professor of Adolescent Health Research, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.