A mother’s time following the birth of her child is a complex and often overwhelming period in her life. A great deal of women find this time to be a break from their everyday reality, as mother and child begin to form an intimate bond that acts as a cornerstone to the newborn’s perspective on life. For many of those mothers, though—and for many fathers, as well—the change in their lives following the birth of their child brings with it a period of postpartum depression (or PPD). The impact of PPD can stretch beyond their personal lives and encompass their family as a whole. Understanding this condition is an important initial step in the road toward recovery.
Postpartum depression is regarded by the American Psychological Association (APA) as a specifier, and not a distinct disorder, within the depressive disorder family. The APA’s Diagnostic and Statistical Manual’s fifth edition (DSM-V) elaborates on its status, stating that postpartum depression can be applied to a major depressive episode, provided it appeared during pregnancy or within the first four weeks following delivery.
Since it is not viewed as its own disorder, the main feature of postpartum depression is that of all depressive disorders. Symptoms such as feelings of sadness, emptiness, low mood, and a sense of lacking effect the individual’s ability to function in conjunction to pregnancy or delivery.
Among the disorders postpartum depression can be associated with is major depressive disorder (or MDD), a mental health condition that causes a significant decrease in one’s mood, a great deal of unhappiness, and a lack of energy. For this reason, instances of postpartum depression should be taken seriously and treated with care and compassion.
A number of risk factors have been shown to increase the likelihood of developing PPD:
Societal expectations can also hinder a new mother’s well-being. These expectations may lead to placing her own needs on hold and an adjustment on the way she views herself as an individual and in relation to others. Together, the above factors can weigh on a woman long after she gives birth. Stressors such as these can contribute to the development of postpartum depression, even as the woman experiencing them tries to push it aside and care for her child as best she can.
According to the DSM-V, 3-6% of women are due to experience a major depressive episode during their pregnancy or in the weeks or months following delivery, with the US National Institute of Health citing research findings of up to 15%. Even at the lower end of this spectrum, these figures convey the high and often overlooked prevalence of this condition.
The DSM-V lists postpartum depression under the collective “peripartum onset” specifier. This is due to research showing that half of pregnancy-related major depressive episodes begin prior to delivery. Listing them together helps raise awareness of the fact that depressive symptoms can occur at different stages during and following one’s pregnancy.
Peripartum depression can be indirectly used to predict the development of postpartum depression. This is due to two related factors:
Together, these findings deduce that peripartum depression can indirectly increase the chances of developing postpartum depression.
Postpartum depression can sometimes include psychotic features, though such cases are more rare. PPD with psychotic features can result in thoughts of self-harm, harming one’s child, and in particularly tragic cases, acting on such thoughts.
Research has also considered the mental health vulnerability experienced by first-time mothers (referred to in scientific literature as primiparous women). Namely, studies have shown a possible connection between first-time mothers and a higher risk of developing both postpartum depressive or manic episodes.
Research on postpartum depression among fathers is less prevalent and has yet to focus its data on more exact figures. As a result, current studies place the development of paternal PPD somewhere between 4-25%.
That said, certain correlations and causations have been found among fathers, as well. For instance, paternal PPD was discovered to have a high comorbidity with maternal PPD, so that the appearance of postpartum depression in one parent increases the risk of the second parent also developing this condition.
Paternal PPD has also been found to cause a negative impact in the family unit, reflected in increased tension within that father’s relationship with the mother. It has also been shown to contribute to the development of emotional and behavioral problems among the family’s older children. It remains unclear, though, whether paternal PPD causes such issues through the father’s direct relationship with his children or indirectly through the PDD’s effect on the father’s relationship with the mother.
It has additionally been shown that fathers, as well as mothers, experience hormonal changes, with their levels of testosterone, estrogen, and cortisol all affected during the postpartum period. This may play a role in the development of PPD, as well as biological risk factors for fathers.
Finally, a lack of social support, feeling excluded from the mother-infant bond, and stress over becoming a parent can also facilitate the development of paternal PPD.
Adoptive parents do not experience the same physical and hormonal fluctuations as a child’s birth mother does. They do, however, go through many life changes and can experience a great deal of stress, guilt over not necessarily forming an immediate bond, and contending with their own unrealistic expectations following the adoption of their child. According to research, these factors can lead to the development of post-adoption depression or anxiety among adoptive parents.
The idea behind postpartum depression is that sometimes, the staggering post-pregnancy changes to a mother’s life—and a father’s—can lead to feelings of deep and unwavering sadness, despite the positive impact that having a child can cause. What, then, can we say in cases where a pregnancy ends in the loss of the child? Does developing depressive symptoms in such a case truly warrant an explanation?
The answer to this question seems to be multi-tiered. On a semantic level, postpartum depression refers to a depressive episode following delivery and relating to experiencing pregnancy or childbirth. As such, depression following pregnancy loss could be considered postpartum.
What may prevent such a tragic case from being considered a depressive episode at all, is mourning. Centrally defined as an intense sadness over the loss of a loved one, mourning is nevertheless not considered a disorder but a normal part of our life experience. That said, it can feel extremely similar to depression, often making it hard to distinguish between the two.
But while mourning is consciously tied to a specific loss, depression tends to paint over the individual’s life, making their general existence difficult to bear. Additionally, while mourning usually becomes less intense over time, depression is more likely to persist and stay with the individual for a longer period of time.
Those who have suffered a pregnancy loss may go through a period of mourning that eventually turns into depression. Their loss can feel insurmountable and requires the understanding and support of those around them to heal.