Postnatal Depression Causes
It is a common form of depression which affects around one in six women after they have given birth. However, postnatal depression (PND) often remains undiagnosed with only one in four cases diagnosed and treated. In this article we will talk about what causes this depression.
Stressful life events
Recent Stresses: When these occur in close proximity to pregnancy or childbirth they can add to stress levels.
The experience of a major life event within the past twelve months is a common cause of stress leading to depression. Examples include: the death of a family member or close friend, loss of employment, migration or relocation away from family and friends, a major illness and relationship problems. These are more likely to trigger an episode of the non-melancholic subtype of depression.
The events that are most likely to trigger depression are ones where the individual’s self-esteem is put at risk, compromised or devalued. For most adults, self-esteem is closely linked to an intimate relationship as well as other important areas such as their job. The break-up of a relationship or the loss of a job because of a pregnancy are common triggers for depression
Other individuals develop depression when they feel a sense of ‘shame’ such as when they feel they have not lived up to their own or others expectations. Feelings of being an inadequate mother are often ‘shame-based’ and due to self-critical thought patterns learned during childhood, often from one’s own parents.
Past and chronic stress: There is evidence to show that growing up in an abusive or uncaring family, or exposure to physical, sexual, or emotional abuse can lead to low self-esteem, patterns of social avoidance, and vulnerability to depression in later life.
These experiences can lead to heightened distress or feelings of increased vulnerability in the face of subsequent stressful life events. Childbirth itself can trigger memories of past events that involved pain or distress including physical or sexual abuse.
The Need for Attention
A new mum needs to be able to exchange attention with her child but can feel this is a one way deal – she doesn’t get enough attention in return, or the attention she receives is not the sort she may have been expecting. This will inhibit the essential bonding that needs to happen if the child is to flourish.
Connection to the Community
Ideally, a mother needs connection with family, friends, and other young mums in her community. They can give her the emotional support she needs to feel confident caring for her baby. If she feels incompetent, however, and is experiencing difficulties in adapting to motherhood, this will undermine natural feelings of self-worth. Single mothers who are on their own are far more likely to suffer from postnatal depression. As she enters motherhood she needs the security of a family unit around her and friends to help them out to reduce the likelihood of developing a severe low mood that could cause postnatal depression.
The Need to Feel Competent
The feelings she is having because of hormonal changes may cause frequent crying for no obvious reason. She may be unprepared for the arrival of the baby and feel out of her depth when realising the extent of the responsibility she now has, caring for her new born. Unanticipated difficulties around breast-feeding can undermine her sense of achievement and competence, as can difficulties around concentrating and making reasonable decisions, which is always a problem when one is emotional.
Biological Risk Factors
Level of many hormones , including the sex hormones testosterone and estrogen, the stress hormone cortisol, and bonding hormones such as vasopressin and prolactin, fluctuate during the postpartum period. These may contribute to the risk of PND. Reduced testosterone helps to develop a lower aggression level and a greater infant-father bonding, bringing about a greater nurturing response in fathers. However, low testosterone levels are associated with depression in men.
Environmental Risk Factors
The presence of depression in the mother is consistently linked to a 2.5 fold increase in the rate of depression in fathers 6 weeks after childbirth. This is the most closely associated risk factor, and men whose wives suffer from PND have a 24 to 50 percent incidence of depression themselves.
Other factors include:
The need to earn more to provide for a new baby and possibly a depressed or sick wife
Lack of sleep
Loss of free time for recreation, family dates, and building relationships with the partner
Stress from having to care for sick or fussy babies
Fear of inadvertently harming the baby
Fear about the baby’s health
Lack of social support
Lack of know-how with respect to baby care
Increased need to help out at home
Heightened levels of discomfort, pain, stress and anxiety during labour and childbirth are normal especially the first time a woman gives birth. However childbirth-related stress levels can be heightened after: delivery of a very preterm or sick baby; an emergency delivery; a long and painful labour and birth perhaps including instruments to aid in the delivery; birth of a baby that is slow to breathe or has an abnormal appearance. It is the way the mother experiences the labour and birth that determines whether it is stressful for her, rather than the way the partner or the doctor perceives the process.