PERINATAL DEPRESSION (FORMERLY POSTPARTUM DEPRESSION)

Perinatal depression is one of the most common depressive disorders in women; characterized by sadness and/or loss of interest in previously enjoyed activities. 

What Is Perinatal Depression?

Perinatal depression is a mood disorder that happens amid pregnancy and after childbirth, characterized by indications such as extreme sadness, lack of interest, and/or anxiety, as well as changes in sleep, appetite, and vitality.

Previously, we often knew about this problem through the phrase "postpartum depression". However, this term only covers depression that occurs after childbirth, while depression related to childbirth can begin during the mother's pregnancy. Therefore, the concept of "perinatal depression" is more general and complete.

If not detected early and treated promptly, perinatal depression can lead to postpartum mental disorders (such as confused thinking, unstable emotions, hallucinations, paranoia, etc.). More seriously, mothers with perinatal depression have a high risk of suicide in the postpartum period, especially those who have other mental disorders and use drugs. Furthermore, harming/murdering a child is the foremost genuine danger of severe perinatal depression. A pregnant woman can harm her baby within the first 24 hours after birth (neonaticide) or later, until the baby is one year old (infanticide). Therefore, perinatal depression is an issue that cannot be overlooked in reproductive health care for women during pregnancy and after childbirth.

How To Recognize Perinatal Depression?

Perinatal depression is manifested at many levels, occurring in 15 - 85% of pregnant women. According to statistics from the US CDC, 1 in 8 women who give birth suffer from perinatal depression. In Vietnam, statistical data from 2010 to 2020 shows that the proportion of women with this disorder at 1 - 12 months after giving birth ranges from 8.2 - 48.1%.

Common symptoms of perinatal depression include:

  • Feeling sad or having a depressed mood

  • Misfortune of intrigued or joy in exercises you once delighted in

  • Change the taste

  • Difficulty sleeping or sleeping too much

  • Loss of energy or feeling exhausted

  • Expanded careless physical action (e.g., failure to stand still, pacing, wringing of arms) or moderated movements/speech - these must be serious enough to be effortlessly taken note of by others

  • Feeling worthless or guilty

  • Difficulty thinking, concentrating or making decisions

  • Thoughts about death or suicide appear

  • Cry for no reason

  • Lack of interest in a baby, not feeling attached to the baby or feeling very worried about/around the baby

  • Feeling like you are a bad mother

  • Fear of harming the baby or yourself

WARNING: The symptoms listed are for reference only. If you suspect you have perinatal depression, see a psychologist at a reputable psychological/psychiatric assessment and treatment facility for an accurate diagnosis.

Diagnosis Of Perinatal Depression

In fact, it is not easy for a person without psychological expertise to recognize that a person is suffering from perinatal depression; the signs can overlap with common emotional disorders such as insomnia, fatigue, anxiety, poor diet, etc. Any woman who is pregnant or has just given birth can experience these emotions. Therefore, timely access to diagnosis plays an extremely important role.

Women may develop these symptoms during pregnancy or within 4 weeks of giving birth, but they do not meet the full criteria for a depressive episode. In that case, perinatal depression may be diagnosed. 

The onset of perinatal depression may or may not have features of psychosis. Harming/murdering the child is often associated with postpartum psychotic episodes, such as hallucinations that someone ordered the child's murder, or hallucinations that the child is "possessed". However, psychosis can also occur during severe postpartum depression without the mother having the specific hallucinations above. If a woman has experienced postpartum psychotic symptoms, the risk of recurrence with each subsequent delivery is between 30% and 50%.

As mentioned above, perinatal depression needs to be carefully evaluated by a professional. However, it is difficult to determine the exact time of onset of perinatal depression, as well as assessment methods for early detection. Especially when signs such as fatigue, emotional changes, lack of sleep, or poor diet are symptoms that often occur in pregnant and postpartum women. The Society of Obstetrics and Gynecology recommends that the ideal time for examination and evaluation is between 2 weeks and 6 months after giving birth because the peak onset of depression is about 90 days after giving birth.

Factors That Can Lead to Perinatal Depression

Biological factors

Any woman who is pregnant/has recently given birth may experience symptoms of perinatal depression or other disorders. Rapid changes in sex, stress hormones, and thyroid hormone levels during pregnancy and postpartum have a dramatic impact on mood and may contribute to perinatal depression. Some other risk factors include physical changes related to pregnancy, giving birth in the intensive care unit (NICU), or medical complications for the mother or baby.

Personal factors

Among personal factors, a low educational level is considered a risk factor for perinatal depression. In particular, mothers with elementary or middle school education have a higher risk of perinatal depression than mothers with high school education. Lack of knowledge and experience about perinatal depression, not being well-prepared for motherhood, and dissatisfaction with new life after giving birth are also personal factors that can cause perinatal depression in pregnant women. In addition, pregnant women are at higher risk of developing perinatal depression if they (or family members) have previously had a history of depression or other mental disorders.

Family factors

Family factors can lead to perinatal depression. Among them, lack of family support and poor relationships with family members are two important factors. A study related to Chinese culture also found that women may be more vulnerable to family support after giving birth due to physiological and psychological changes. Mothers who care for sick children are more likely to develop perinatal depression. In addition, women who are physically, mentally, and sexually abused by their husbands are also at high risk of developing perinatal depression. In particular, in the Vietnamese cultural environment, the husband's preference for a son/daughter is also a risk factor that can cause perinatal depression in the wife.

Environmental factors

Regarding environmental factors, stressful life events (such as economic shock) are strongly associated with perinatal depression in new mothers. In Vietnam, pregnant women who live in rural areas and lack social support/response are 2 to 4 times more likely to suffer from perinatal depression than women who live in cities and have adequate social support. In particular, traditional customs in Vietnam (such as confinement, forced body keeping, not bathing, etc.) that last for a long time are risk factors for perinatal depression in women. In addition, changes in relationships and the work environment after giving birth, anxiety about parenting, and a lack of sleep can also contribute to perinatal depression.

Psychological Treatment For Women With Perinatal Depression

Psychotherapy

In expansion to utilizing pharmaceuticals to deal with symptoms, psychotherapy gives people the knowledge and skills to manage perinatal depression. There are two commonly used therapies: cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). CBT focuses on negative outlooks and thinking patterns that can affect mood, thereby helping individuals make positive changes in their thinking and behavior. Meanwhile, IPT focuses on how individuals interact with others, helping individuals make positive changes in their interpersonal relationships. Both of these therapies are effective in the long term for treating depression in general and perinatal depression in particular.

Support from people around

The encouragement of friends, relatives, and especially the husband plays a significant role in the treatment of perinatal depression. For pregnant women with this disorder, this bond helps them fight and overcome bad moments. Therefore, family and friends need to show care, share, and be close to women, helping them reduce feelings of loneliness as well as limit postpartum pressure and fatigue.

If you feel you are having symptoms of perinatal depression, go to a medical facility for timely examination and diagnosis, or contact the Vietnam - France Psychology Institute via Hotline: 0979.158.463 for specific advice. Early intervention is key to improving health and quality of life.

References:

[1] Trầm cảm sau sinh. https://hosrem.org.vn/public/frontend/upload/YHSS_44/12.pdf

[2] Perinatal Depression (formerly Postpartum). https://www.psychiatry.org/patients-families/peripartum-depression

[3] The Rate and Risk Factors of Postpartum Depression in Vietnam From 2010 to 2020: A Literature Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8578872/

[4] Diagnostic and statistical manual of mental disorders _ DSM-5. https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf

[5] Perinatal Depression. https://www.nimh.nih.gov/health/publications/perinatal-depression#:~:text=Perinatal%20depression%20includes%20depression%20that,after%20the%20baby%20is%20born

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VIETNAM - FRANCE PSYCHOLOGY INSTITUTE

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PSYCHOTHERAPY CENTER IN HCMC: Landmark 81 & Landmark Plus, Vinhomes Central Park, 720A Dien Bien Phu Street, Ward 22, Binh Thanh District, HCMC, Vietnam

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