Postnatal depression 'often unreported'

Behind the Headlines

Monday October 3 2011

Postnatal depression can be treated

Rates of postnatal depression may be higher than previously estimated, a children’s charity has claimed today. Various medical sources estimate that around 10-15% of new mothers are affected, but according to the charity 4Children around 3 in 10 new mothers may experience the condition.

The figure is based on a new survey and report conducted by the charity in a bid to look at how postnatal depression (PND) is perceived and treated in the UK. According to the figures gathered by the charity:

  • Approximately 33% of mothers who experienced depression symptoms during pregnancy went on to have PND.
  • Approximately 25% of mothers still suffered from PND up to a year after their child was born.
  • Approximately 58% of new mothers with PND did not seek medical help. This was often due to them not understanding the condition or fearing the consequences of reporting the problem.

Based on its findings, the charity has called for changes in the way that postnatal depression is handled, including campaigns to raise awareness and improve diagnosis of the condition.

It is important that pregnant women or new mothers who are feeling low discuss the problem with a health professional, as these symptoms may be due to PND rather than normal hormonal changes and tiredness. While the new survey suggests that mothers with the condition avoid seeking help, it is definitely worth doing so as there are a number of effective treatments available.

 

What did the survey look at?

The charity 4Children conducted a survey of 2,318 new mothers to collect information about their awareness and experiences of postnatal depression, and to estimate how many mothers suffer from the condition. The charity says it worked with the Bounty parenting club to carry out the survey, although it is not clear how the participants were identified or if they were part of the parenting club.

The survey addressed a number of aspects of PND, including perceptions of the condition among new mothers, the attention the NHS gives to the condition and access to services to treat PND. The report goes on to make recommendations on how to improve awareness and treatment of the condition in order to minimise the negative impact on new mothers, families and children.

 

What is PND and what are the symptoms?

A proportion of mothers will experience depression around four to six weeks after giving birth. There is a broad range of symptoms that women with PND may experience, and as well as the obvious symptom of feeling low, those affected may also have feelings such as loneliness and guilt, or experience tiredness and sleep problems.

The condition is distinct from ‘baby blues’, a short-term drop in mood reportedly experienced by approximately 80% of new mothers. The baby blues disappear within a week or so, whereas postnatal depression symptoms are longer lasting and can sometimes interfere with day-to-day life. Symptoms can include feeling an inability to connect with or look at the new baby, and feeling too anxious to interact with friends and family.

In its report, 4Children say that it considers new mothers to have PND if they experience three or more of the following symptoms:

  • low mood
  • constant exhaustion
  • inability to cope
  • feelings of guilt regarding their inability to cope or not loving the baby enough
  • overwhelming anxiety
  • difficulty sleeping
  • lack of appetite
  • difficulties bonding with the baby
  • relationship difficulties with the partner
  • low energy
  • low sex drive
  • social withdrawal (from family and friends)
  • crying for no reason

Those who experience three symptoms are considered to have mild PND, five-to-six symptoms to have moderate PND, and those experiencing more than six to have severe PND.

There are still questions as to why mothers develop PND, but current theories tend to focus on it being caused by changes in hormone levels, or the idea that genetic predisposition interacts with environmental and social factors to bring about symptoms.

 

How is postnatal depression currently treated?

Current NICE guidance on antenatal and postnatal care recommends that healthcare professionals routinely ask pregnant women three questions regarding experiencing symptoms of depression. This is intended to identify antenatal depression, raise the mother’s awareness of baby blues and postnatal depression, and identify risk factors for postnatal depression.

Around two weeks following birth women should be assessed for resolution of baby blues and assessed for depression if symptoms are persisting. Guidelines emphasise the need for early identification and treatment of depression during pregnancy or after birth, and the importance of ensuring that mothers are aware of all available treatment options.

Psychological ‘talking’ therapies are recommended as first-line treatment of mild and moderate cases of antenatal or postnatal depression. However, antidepressant treatment may be considered, with the risk-benefits associated with such treatment in pregnant or breastfeeding women taken into account.

Guidance also emphasises the need to address the impact of postnatal depression across the whole family, with services tailored to meet the needs of not only mothers but also fathers, partners and children.

 

What did the survey find?

The report looked at several different aspects of women’s experiences with PND. Below is a selection of some of its key findings.

 

Prevalence

When looking at the prevalence of the condition, the survey found that:

  • 33% of new mothers with more than one child reported suffering from PND; of this group, 54% sought professional treatment
  • 26% of first-time mothers reported suffering from PND; of this group, 42% sought professional treatment

 

Awareness

In terms of awareness of the condition and available treatments, the survey found that among new mothers who were experiencing PND, reasons for not seeking treatment were reported as:

  • thinking it was not serious enough to warrant professional treatment (60%)
  • being too scared to tell someone, for fear of consequences (33%)
  • not realising until later that they were experiencing PND (29%)
  • feeling that support from family and friends was sufficient to address the condition (28%)
  • lacking sufficient support from their partner to seek treatment (13%)
  • lacking sufficient information to know what to do (12%)

Across all the women surveyed, 43% said they thought that partners needed more information about the symptoms of PND.

 

Seeking treatment

Of those mothers who did seek professional treatment:

  • 47% sought treatment within three months of the onset of symptoms
  • 23% waited between three and six months after the onset of symptoms
  • 27% waited over six months after the onset of symptoms
  • 3% could not recall when they sought help

Among women that sought professional help, 22% said they were unsatisfied with the treatment they received.

 

Treatment methods

Of those who received treatment:

  • 70% received antidepressant medication
  • 41% received counselling or talking therapy
  • 12% received help from the local Sure Start Children’s Centre
  • 7% received help from an associate such as HomeStart or Women’s Aid
  • 6% were treated by a psychologist
  • 2% received inpatient psychiatric hospital treatment

Those who sought help often reported feeling that their treatment was overly reliant on the use of antidepressant medication, and that they did not have easy access to psychological therapies - the preferred treatment option for mild postnatal depression, according to NICE guidelines.

 

What does the report recommend?

The report contains a variety of recommendations to improve the treatment of PND in the UK. The recommendations focus on improving awareness, social support and appropriate and timely treatment. The charity calls for:

  • A national campaign led by the Department of Health to raise awareness of symptoms and to dispel myths and stigma surrounding PND. This should be done in conjunction with civil, volunteer and business groups.
  • Improvements in antenatal screening and the early identification of risk factors, including relationship conflict, social isolation and financial or employment concerns.
  • The reintroduction of antenatal health visitors. 4Children says an early and continuous support relationship can improve identification and treatment of PND.
  • Education to improve healthcare professionals’ knowledge of how to identify and treat PND.
  • Measures to ensure that GPs and other health professionals are committed to offering appropriate and timely psychological therapies, as recommended by NICE guidelines.
  • Improvement in the way data relating to the prevalence and treatment of PND is collected across the NHS.
  • The improvement of certain regions’ inpatient treatment of acute PND through the creation of inpatient mother and baby units. The report says that at present Northern Ireland, northern Scotland, north Wales, East Anglia and the South West of England are underserviced.
  • Steps to ensure practical and emotional support is available from local support groups, including provision for fathers and partners. These should have an emphasis on strengthening family relationships.

 

Where can I get help with PND?

The NHS recommends that new mothers who suspect they are suffering from PND see a healthcare professional such as their GP, midwife or health visitor as soon as they can. Talking treatments such as cognitive therapy, cognitive behavioural therapy (CBT) or interpersonal therapy have been shown to have the same success rate (50-70%) as antidepressant medication in the treatment of moderate PND. Our section on postnatal depression has further information on the symptoms of PND and treatments for PND.

It is also important that pregnant women speak to their GP, midwife or health visitor if they have any concerns about developing PND, and mention any previous experience with depression or anxiety. This will ensure that appropriate care is received and may help to prevent PND.

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Analysis by Bazian

Edited by NHS Choices