The collective imagination depicts the pregnancy and postpartum stage as an idyllic moment, impregnated with joy no matter what, in all circumstances. No other scenario is contemplated. But reality, although often invisible, is more complex than all that: there may be happiness and excitement, but also in these stages there are tears for no apparent reason, sadness, anxiety or a feeling of emptiness that, at times, can lead to serious mental health problems. Unpublished this Thursday in the magazine The Lancet Psychiatry has put figures on severe depression in the peripartum period—during pregnancy and up to a year after giving birth—and has concluded that at least one in 16 women suffers during these stages. The two weeks after birth are the most critical phase, where there is the highest risk of experiencing this mental disorder.
Alize Ferrari, researcher at the University of Queensland (Australia) and author of the study, says that the scientific community knew that the prevalence of this disorder was higher among women during pregnancy and postpartum than in the general population, but they did not know the magnitude of that difference. The scientific evidence was limited. Some studies estimated the prevalence of this disorder at up to 14% and 17%, but the authors point out that the study methods were sometimes inconsistent, with lax criteria and measurement errors. The new research, arising from a scientific review in which data has been collected from two million women and girls from 90 countries, concludes that severe depression appears in 6.2% of women during pregnancy (that is, one in 16) and in 6.8% of mothers (one in 15) during the first year after giving birth.
The study reopens a melon that shakes the entire cultural narrative around birth as a luminous stage. “For many women, it is not an idyllic postcard. And it is not about weakness or lack of love, but about biological processes and a heavy history,” she explains, regarding postpartum depression, in her book It will be because of the hormones.
After analyzing the study, in which she did not participate, the same doctor, who practices at the Vall d’Hebron Hospital in Barcelona, assures that Ferrari’s research is “very powerful methodologically and represents a solid contribution to prevalence because it helps to organize heterogeneous studies.” Now, the psychiatrist asks for caution in interpreting the results to “not underestimate.” “Here they evaluate major depressive disorder, but not other common postpartum disorders that are equally disabling,” he emphasizes.
Parramon refers, for example, to baby blueswhich presents with mild depressive symptoms, such as irritability or sadness. This condition may not meet the criteria for a diagnosis of severe depression, but if it becomes chronic and worsens, it can lead to that. “The reading should not be that there is less postpartum depression than we thought. There are other subdepressive cases [que no cumplen todos los criterios técnicos para ese diagnóstico] “That can be very important and impact functioning and motherhood,” he emphasizes.
The psychiatrist suspects that this difference in prevalence between studies (some of up to 17%, much higher than Ferrari’s results) is due precisely to the fact that in some investigations clinical conditions of different severity can be mixed under the same heading of postpartum depression.
Ferrari’s research excludes these transitory states of sadness and emotional lability and focuses on the most complex scenario of the mental framework that surrounds peripartum. Major depression, unlike those mild and temporary mood swings of postpartum blues, involves serious and persistent symptoms: there is grief and grief, but also loss of interest and difficulty in functioning on a daily basis.
The prevalence of severe depression remains higher than in the general population at all stages of the peripartum period, but is especially high (8.3%) two weeks after birth. “Our findings emphasize the need for early identification and intervention for major depressive disorder throughout the peripartum period, but especially as women and girls approach the end of the first two weeks after childbirth,” reflects Ferrari.
Eduard Vieta, head of Psychiatry at the Hospital Clínic of Barcelona, recalls that “in Spain there are few devices and programs specialized in caring for women’s mental health during this period.” “In most cases, women with postpartum depression are not treated comprehensively through centers that allow the treatment of depression without neglecting the needs of the newborn and attachment, which is essential for a healthy emotional relationship between mother and baby, and its subsequent evolution. This work indicates that we have to promote attention to mental health during pregnancy and the postpartum, and develop specialized programs and centers,” says the expert in statements to the SMS portal.
Biology and biography
The reasons behind this increased vulnerability to poor mental health during pregnancy and childbirth are diverse. It has an influence, point out the experts consulted. “The increase in the prevalence of major depressive disorder in the peripartum period is likely due to a complex interaction between various stressors, such as abuse and violence, biological factors, poverty, growing inequality, differences in access to health services, barriers to medical care and other factors that influence the support that women and girls receive during the peripartum period in different countries,” Ferrari points out. According to their data, the prevalence of major depression in these stages was highest in southern sub-Saharan Africa and southern Asia; and was lower in the high-income Asia-Pacific region.
Parramon maintains that “major depression can be reached in many areas.” Hormones influence, for example: after childbirth there is a sudden hormonal drop and women with high hormonal sensitivity in the brain may experience more severe symptoms after this drop, he points out. That would explain, to a large extent, why Ferrari’s research finds a peak in severe depression at the beginning of the postpartum period, coinciding with this hormonal decline.
However, Parramon adds, there are also psychosocial factors. From socioeconomic living conditions to family relationships or the distribution of. “Contextual aspects and also the expectations we have influence: motherhood is, at times, very demanding and is anything but self-care. There are depressions that come from the self-demand of fulfilling what society has told them they have to do to be good mothers.”
invisible illness
The endocrinologist Carme Valls emphasizes in her book Invisible women for science that postpartum depression is recognized as an entity, but it is made invisible. “It is not clear when it takes place due to vital conditions and conflictive relationships, personal loneliness in the face of the task or endocrine alterations or deficiency states that have remained invisible because they have not been investigated either.”
This doctor emphasizes that circumstances as diverse as the symptoms of anemia, together with the lack of domestic help or fatigue from the breastfeeding phase, especially if there is no co-responsibility in care and household chores, “contribute to the feeling that some women have that they will not be able to cope with the task of raising their children, partly favoring the presence of postpartum depression.”
The layer of silence and ignorance that surrounds these paintings, added to the weight of the rigid social conventions that color these stages of obligatory joy, do not help to dismantle myths and are very invalidating.
