Thursday June 12 2014
Mums who do not ask for help may be at risk
“’Super-mums’ … may be more likely to suffer from depression, researchers say,” the Mail Online reports. A US study found a possible association between concern about being perceived as a perfect parent and maternal depression risk.
The researchers developed a 26-item questionnaire designed to assess what they described as “rigidity of maternal beliefs scale” (RMDS).
Women with a high RMDS score had very fixed notions about the role of motherhood and the responsibilities it brings.
For example, they agreed strongly with statements such as “I should do everything for my baby myself” and “Having negative thoughts about my baby means something is wrong with me”. Though these types of beliefs are unlikely to match the messy reality of bringing up a baby.
The researchers did find that women with a high RMDS store had an increased tendency to develop postnatal depression.
This was a small study but the thinking underpinning it seems plausible. Mothers who assume that motherhood is always going to be joyous may be more likely to end up depressed when they are confronted with the reality of the situation.
Having a baby is certainly joyful but it is never easy. It’s important new parents feel they can call on others for support – rather than believing they must do everything themselves.
Where did the story come from?
The study was carried out by researchers from the University of Michigan, Florida State University and was funded by the University of Michigan.
The study was published in the peer-reviewed journal Depression and Anxiety.
It was covered fairly if in rather loose terms by the Mail Online.
The site did not explain the study’s aim – to design and test a measure of women’s beliefs and how these are related to postnatal depression.
What kind of research was this?
The researchers say that perinatal (or postnatal) depression has a negative impact on women, parenting and children’s development. Yet little is known about how far maternal beliefs or attitudes are associated with depression.
They suggest that “rigid” beliefs such as believing you must “fix” all parenting difficulties yourself may be associated with lower mood during the postnatal period.
Their aim here was to create and test a questionnaire for pregnant women and new mothers, examining their beliefs in three areas closely related to mood and behaviour:
- whether a mother thinks she is competent (maternal self-efficacy)
- whether she believes babies get hurt or sick easily (perceptions of child vulnerability)
- whether she internalises societal beliefs about what good mothers should do and feel (perceptions of societal expectations)
They then aimed to test whether the results from the questionnaire could identify women at risk of postnatal depression.
What did the research involve?
The researchers initially developed a 30 item measure, called the Rigidity of Maternal Beliefs Scale (RMBS). They did this after consulting with expert clinicians and researchers in the field of women’s mental health and conducting a review of the existing literature, as well as interviewing depressed women.
They also created a seven point answer scale, ranging from 1 (strongly disagree) to 7 (strongly agree), with high scores suggesting more rigid beliefs and lower scores more flexibility.
After piloting the measure with a small group of depressed women, they removed six of the items, resulting in 26 final items.
The RMBS was designed to cover four, inter-related, areas of belief:
- perceptions of societal expectations of mothers – beliefs about the responsibilities of motherhood – such as “I should do everything for my baby myself” and “I should be able to figure out and fix parenting difficulties myself”
- role identity – beliefs about the experience of motherhood, such as “being a mother should be positive” and “babies get hurt or sick easily”
- maternal confidence – how confident (or not) they feel about being a mother and how this level of confidence compares to other mothers
- maternal dichotomy – beliefs about what makes a “good” or “bad” parent, both in terms of individual thinking and how others perceive them, such as “if my baby misbehaves, then others will think I am a bad parent”
The questionnaire was sent out to women twice – once during pregnancy and again, after the baby’s birth.
The women were also asked to complete a validated questionnaire to assess depressive symptoms.
They were also asked to fill out a further, eight item self-report questionnaire, called the parenting sense of competence scale (PSOC).
Women were eligible to participate in the study if they were pregnant, over the age of 18, fluent in English, and had no adoption plan. The prenatal questionnaires were mailed out to 273 women who met the criteria, 134 women returned the questionnaires, giving a response rate of 49%. Of those, 113 women (84%) also returned postnatal questionnaires, participating at both study time points.
They analysed the results, looking at women’s scores on the new measure, their scores on the parental competence scale and their scores on the depression scale.
What were the basic results?
The researchers found their 24 item scale was a reliable, valid measure for predicting postnatal depression. Women who scored higher on the Rigidity of Maternal Beliefs Scale were associated with a higher risk of developing postnatal depression.
They found that such a questionnaire could be divided into four areas reflecting a mother’s Perception of Society’s Expectations, Role Identity, Maternal Confidence and Maternal Dichotomy (mothers’ belief they are categorised into “good” and “bad” based on how their child behaves).
How did the researchers interpret the results?
They say their results suggest that the RMBS could be used as a valid, reliable measure to examine these areas of maternal beliefs, and to identify those at risk of postnatal depression. They argue that the RMBS should now be tested on a larger, more diverse sample of women.
This was a small study of relatively highly educated, high income women, most of them with partners, so whether its findings are generalizable to all new mothers is uncertain.
The study did not take account of stressful events which can adversely affect mental health such as relationship or financial difficulties.
Still, many experts agree with the thinking underpinning the study.
Having unrealistic beliefs and expectations about the experience of motherhood could make a woman more vulnerable to depression if she is unable to come to terms with the reality of the situation; especially if she does not seek help and support from others.
Having a baby can bring great joy but with that joy can come an immense amount of stress which can trigger depression. As one expert in the field put it “I’m not surprised that some mothers develop depression. What surprises me is that all mothers don’t develop depression.”
If you are concerned about your mood you should ask yourself two questions:
- During the past month, have you often been bothered by feeling down, depressed or hopeless?
- During the past month, have you often been bothered by taking little or no pleasure in doing things that normally make you happy?
If the answer to either of these is yes, then it is possible you have postnatal depression. You should contact your GP for advice.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.