Postpartum Depression and how Psychotherapy can help

By Haley Blumenfeld, RSW

Postpartum depression is a powerful mood disorder that affects roughly thirteen percent of women within the first year of delivery (Stewart et al., 2003). While postpartum mood disorders (PMD) are common, affecting 1 in 5 women during pregnancy or up to one year after giving birth or adopting a baby, it is something largely left on the back burner, swept under the rug when focusing on maternal health (Region of Peel, 2017). PMD is a group of disorders that most commonly include PPD and anxiety disorders (Region of Peel, 2017). Findings from a massive population-based study revealed that PPD is the largest complication associated with childbirth or motherhood (O’Hara & Swain, 1996). The onset of PPD typically occurs within one to twelve months following childbirth and most cases require care by a professional, such as a Registered Social Worker (RSW) (Stewart et al., 2003).

The signs and symptoms of PPD are very similar to those connected with major depression, such as low mood and energy levels (Stewart et al., 2003). Women with PPD generally experience sleep issues, crying and sadness (Stewart et al., 2003; Robinson & Stewart, 2001). Often women with PPD endure appetite reduction, irritability and poor concentration (Stewart et al., 2003; Robinson & Stewart, 2001). Many women with PPD also feel significant worry with regard to their baby’s health and view themselves as incompetent or unloving mothers (Stewart et al., 2003; Robinson & Stewart, 2001). The overlapping of symptoms of major depression and common experiences linked with the transition to parenthood present challenges when screening for PPD (Nonacs & Cohen, 1998; Hostetter & Stowe, 2002).

Screening and Diagnosis

Although PPD is a major health issue that impacts a large percentage of women, PPD greatly “remains undiagnosed and untreated” (Stewart et al., 2003, p.4). Cox et al. (2016) found that “85 percent of women do not receive proper treatment due to a lack of resources” such as inadequate physician training or knowledge (Tomasi, 2017; Stewart et al., 2003, Tomasi, 2018, p. 3). Despite already having The Edinburgh Postnatal Depression Scale (EPDS), a self administered, globally used, evidence-based measure that screens for PPD, research reveals that many Canadian health care professionals lack the knowledge to discern PPD symptoms in women, and are not employing the EPDS (Stewart et al., 2003; Williams, 2014). The self-report scale consists of ten short statements about how the mother has been feeling in the past week (Meschino, 2006). Most mothers are able to complete it in less than 5 minutes (Meschino, 2006). The scale has also been validated for use in pregnancy, the first year postpartum, and fathers (Meschino, 2006). Given that PPD can have significant effects on the mother-baby relationship and child development when prolonged exposure occurs, timely identification of women at risk for developing PPD aids in preventing an intensification of symptoms (Motherfirst, 2010; Hayes et al.; Stewart et al., 2003). Timely identification also promotes early intervention, which can provide better overall health to mothers and their children (MotherFirst, 2010).

Psychotherapy

New parents benefit from significant opportunity to talk about their feelings, worries and thoughts (Meschino, 2006). Treatment with psychotherapy for mild to moderate PPD is namely preferred over medication by mothers and health care professionals (Meschino, 2006). Given that PPD often occurs in the context of interpersonal challenges and role transition issues, treatment such as Interpersonal Psychotherapy (IPT), that acknowledges the complex nature of this mood disorder, is commonly practiced (Reay et al., 2012; Stewart et al., 2003). There is a vast amount of evidence demonstrating the effectiveness of IPT for significantly improving PPD symptomology. A very well-designed study conducted by O’Hara and colleagues (2000) found that drastically less women receiving IPT were experiencing PPD at twelve weeks (12.5%) versus women in the standard treatment group (68.6%) (O’Hara et al., 2000).

Getting Support

Haley Blumenfeld is a Registered Social Worker with a Master’s in Social Work (MSW) from the University of Toronto. Haley has received graduate level training in IPT from the University of Toronto and the Reproductive Life Stages Program at Women’s College Hospital. Haley has practiced and successfully treated PPD using IPT in an individual, couple, and group context with new and expecting mothers.

You are not alone, PPD is common and treatable!

References:

Cox, E. Q., Sowa, N. A., Meltzer-Brody, S. E., & Gaynes, B. N. (2016). The perinatal depression
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Hayes, L.J., Goodman, S.H. & Carlson, E. (2013). Maternal antenatal depression and infant disorganized attachment at 12 months. Attachment & Human Development, 15, 133-153. doi:10.1080/14616734.2013.743256

Hostetter, A. L. & Stowe, Z. N. (2002). Postpartum mood disorders. Identification and
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Meschino, D. (2006). Interpersonal and intrapsychic developments of pregnancy: Relevance for perinatal mood and anxiety disorders and for childhood attachment. Facing the challenges: Healthy child development, In Eds. P. Mousmanis, A. Alsaffar, W. Burgoyne, C. Chase, N. Deller, D. Gzik, L. C. McLeod, & M. Munro, M. Ontario College of Family Physicians: Toronto.

MotherFirst. (2010). Maternal mental health strategy: Building capacity in Saskatchewan. Retrieved from http://www.feelingsinpregnancy.ca/MotherFirst.pdf

Nonacs, R. & Cohen, L. S. (1998). Postpartum mood disorders: Diagnosis and treatment guidelines. Journal of Clinical Psychiatry, 59(2), 34-40.

O’Hara, M. W. & Swain, A. M. (1996). Rates and risk of postpartum depression-a meta-analysis. International Review of Psychiatry, 8, 37-54.

O’Hara, M., Stuart, S., Gorman, L., & Wenzel, A. (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives Of General Psychiatry, 57(11), 1039-1045.

Reay, R., Mulcahy, R., Wilkinson, R., Owen, C., Shadbolt, B., & Raphael, B. (2012). The development and content of an interpersonal psychotherapy group for postnatal depression. International Journal Of Group Psychotherapy, 62(2), 221-251.

Region of Peel. (2017). Health after Pregnancy. Retrieved from https://www.peelregion.ca/health/family-health/after-pregnancy/unexpected/mood-disorder.htm

Stewart, D., Robertson, E., Dennis, C., Grace, S., & Wallington, T. (2003). Postpartum depression: Literature review of risk factors and interventions. University Health Network Women’s Health Program: Toronto Public Health. Retrieved  from
http://www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.Pdf

Tomasi, P. (2017). Canada needs to prioritize a national postpartum depression strategy. The Huffington Post. Retrieved from https://www.huffingtonpost.ca/patricia-tomasi/canada-postpartum-depression_b_9593834.html

Tomasi, P. (2018). 6 ways Canada is failing moms with maternal mental illnesses. The Huffington Post.
Retrieved from https://www.huffingtonpost.ca/2018/05/01/maternal-mental-health canada_a_23424672/