Research on depression, anxiety & childbirth

Why do we care?

“Conspiracy of silence”

Affective disorders associated with childbearing have been described since the time of Hippocrates. More recently, in 1838, the French physician, Jean Etienne Dominique Esquirol1, documented cases of mental illness in childbearing women. He divided them into illnesses that arose during pregnancy, soon after childbearing, and weeks or even longer after delivery. Louis Victor Marcé1, also a French physician having a particular interest in psychiatric disorders in postpartum women, in 1858, wrote Traité de la folie des femmes enceintes, a treatise about emotional disorders during pregnancy and after delivery. Modern interest in the subject was revived in the late 1960s, with the publication of the works of James Alexander Hamilton (1962)1 and Bryce Pitt (1968)2, amongst others. While this continued, concurrently during the 1980s, in several parts of the world, the efficacy of self-help and or support groups was being confirmed as assisting postnatal depressed women in their recovery.

Little is known about developments in South Africa, prior to 1987, when the author was involved in the establishment of a facilitated support group for women who were struggling to adjust to their new roles as mothers. These first support groups were set up at The Parent Centre, a project of Child Welfare in Cape Town. Intuiting that the problems of these mothers might, in fact, be a manifestation of Postnatal Depression (PND), the author began to use the Edinburgh Postnatal Depression Scale as a “measuring instrument”, and to refer, where appropriate, for medication and individual psychotherapy. By educating and informing health care professionals and the public about PND and our services, the author, with the Parent Centre, was able, slowly, to reach women and families who were suffering from the effects of postnatal depression (PND). The support groups became therapy groups, and through referrals and word of mouth, the numbers grew. The author undertook several research projects, one of which was published in the SAMJ3.

The author made contact with and joined Postpartum Support International (PSI), and the Marcé Society, and is, at time of writing, a member of the Executives of both these international organizations, which have a practical and academic interest in affective disorders, associated with childbirth. Having been a delegate and presenter at conferences presented by PSI and the Marcé Society, it became clear to the author that Southern Africa needed a support service focusing specifically on women who were experiencing clinically diagnosed anxiety and depression, during pregnancy and post partum.

The Postnatal Depression Support Association of South Africa, (PNDSA), was established as a registered non-profit organization in 1997. Its 230 members include psychiatrists, psychologists, paediatricians, general practitioners, childbirth educators, midwives, and obstetricians, nursing sisters, academics, recovered “survivors” and volunteers. Funding is either by donation from the private sector and individuals, or from membership fees. PNDSA has effectively given support and assistance in many parts of Southern and Sub-Saharan Africa, especially in the Western Cape. By February 2000, the organization had distributed 27 500 pamphlets, and had had direct personal or telephonic contact with more than 1791 depressed mothers. In addition, our volunteers have visited 4210 newly delivered mothers in maternity hospitals. In the Cape Town area alone, more than 3000 support group sessions have been held since 1997.

The author has recently conducted a large research project examining postnatal depression in the broader context of the woman’s life. (It is intended to submit a summary of the, as yet unpublished, findings to this Journal.) There is an urgent need for further community-based support services, and for random controlled research trials to be extended into the less educated and less affluent communities in Southern Africa. Financial stress, poverty and lack of social and instrumental support are known to be risk factors for PND. We are uncertain as to how PND presents and is interpreted by our many different cultural groups.

This is a time when “women’s issues” are “politically correct”. To some extent, lip service is paid to this, particularly in respect of the rights and needs of new mothers. Having a baby requires more recognition than maternity leave, as every parent knows. To be allowed to be at home with her baby does not ensure the mother’s emotional health. To motivate changes in societal attitudes will take time and the co-operation of the academic, medical, corporate and general communities. By encouraging research and education at all levels, we hope to achieve this. The prevalence figures are internationally consistent: At least 1 in 10 mothers in all levels of society, and regardless of socio-economic conditions, experience clinical depression and/or anxiety before, and up to a year, after childbirth. Without sounding too much like a feminist, this raises the question of what would happen if, every time a child was born, one in ten men became clinically depressed!

References:

Hamilton James Alexander, and Harberger Patrician Neel. (Eds.). Postpartum Psychiatric Illness. A picture puzzle. University of Pennsylvania Press, Philadelphia 1992: 5-13.

Pitt B. ‘Atypical’ depression following childbirth. Br. J. Psychiatry 114: 1325-1335.

Mills E.P., Finchilescu G., Lea S.L. Postnatal depression – an examination of psychosocial factors. S.A. Med. J.1995; 85(2): 99-105.

AUTHOR:

E.P. Mills - Founder President PNDSA

 

Understanding PND

Help for Family and Friends

Help for Depression in Pregnancy