Dealing with Depression during Pregnancy – Part 1

This article on Dealing with Depression during Pregnancy will be published on this site in 7 parts.

Background Information - Pregnancy and Severe Depression

Canadian researchers, reporting in BMC Women's Health September 2007, explored the experiences of 19 women in Ontario who were diagnosed with depression during their pregnancy.

Part of the aim of this research was to explore women’s experiences of depression during pregnancy. It is concerned with the women’s personal experiences, how they make sense of those experiences, and how those meanings relate to their management of the disorder.

The model that emerged from their analysis was becoming the best mom that I can.

From the women's perspective, becoming the best mom that I can was the process of “doing everything I could” to implement control over the perceived threat to their pregnancy and their ability to care for the baby after birth.

Becoming the best mom that I can explains the complex process of the women’s journey as they travel from the depths of despair, where the depression is perceived to threaten their pregnancy and their ability to care for the coming baby, to arrive at knowing the self and being in a better place.

Recruitment was conducted through a reproductive mental health program located in a major urban centre in southern Ontario. Purposely recruiting women from the reproductive mental health program and including only women with a psychiatrist diagnosed depression maximized the opportunity of interviewing women who could provide the best and clearest examples of the phenomenon of interest.

In order to reground the self and regain control of their lives, the women had to recognize the problem, overcome shame and embarrassment, identify an understanding healthcare provider, and consider the consequences of the depression and its management.

When confronting and confining the threat of depression, the women employed strategies of overcoming barriers, gaining knowledge, and taking control. As a result of counselling, medication, or a combination of both, women felt that they had arrived at a better place.

Recruitment was a two-step process. First, healthcare providers at the program contacted potential participants by letter alerting them to the study and asking those interested in participating to telephone the first author Heather A Bennett.

Second, women who contacted Heather Bennett were provided an explanation of the study, invited to ask questions, and an appointment was made to meet with women who wished to participate.

In this way, the women could be reassured that their healthcare provider would not know of their decision regarding participation in this study.

Potential participants were provided with a verbal explanation of the study and given the opportunity to ask questions during the initial telephone contact. Women who agreed to participate were given as much time as they required at the beginning of the meeting to read the study information sheet/informed consent form, to ask questions, and satisfy themselves as to the conditions and implications associated with their participation in this study.

Informed consent was obtained in writing prior to the start of the interview. Confidentiality was maintained by assigning each participant a code number. Nineteen women who had experienced depression during pregnancy, as diagnosed by a psychiatrist, participated in the study.

The 19 participants were between 25 and 47 years of age (average age = 36), of varied ethnic backgrounds, and of relatively high socioeconomic status (SES) compared with the general Canadian population. Twelve were university educated, 7 had completed college, and the majority had an annual household income in excess of $75,000 (CDN). Nine women had one child at the time of the interview, nine had two children and one had three children (two women had twins).

Seventeen sought mental health care during pregnancy and two delayed seeking care until the postpartum period. Fifteen women reported that they had experienced at least one episode of depression during their lifetime. Eight women were taking antidepressants prior to conception; three discontinued medication when planning their pregnancy and two upon confirmation of pregnancy. Four of the five who discontinued resumed antidepressants during pregnancy, the fifth resumed in the postpartum.

The pregnancy of interest, that is the pregnancy during which the woman was depressed, occurred on average 1 year (range = 0 to 2.5 years) prior to the interview. This relatively short time period between the pregnancy and the interview served to decrease the likely hood of recall error.

For many women, the idea that depression could occur during pregnancy was contradictory to their vision of the pregnant self. The challenge for a pregnant woman who is diagnosed with depression, is that effective care for her may jeopardize her baby’s future health. This provides a dilemma for about-to-be parents and their healthcare providers.

Improved awareness of depression during pregnancy on the part of healthcare professionals is needed to improve the women’s understanding of this disorder and their ability to recognize and seek help with depression should it occur during the prenatal period.

Major depressive disorder (MDD) is a chronic, recurrent illness associated with considerable disability, impaired quality of life and high economic costs. This serious illness interferes with a person’s ability to work, study, sleep, eat and enjoy themselves. It may appear once in a person’s life, but more often occurs several times. It is common in most countries, with annual rates in the adult population ranging from 7% to 13%. Depression is twice as prevalent in women as in men, and has been identified as a leading cause of disease burden for women aged 15 to 44 years globally.

The mean age of onset of depression for females ranges from the early 20s to early 30s, coinciding with the childbearing years of a woman’s life. The notion that pregnancy is a time of joyful expectation, a satisfying and fulfilling experience for all women, has been exposed as a myth. It is now clear that some women develop depression during pregnancy, while others with a history of depression are at risk for its recurrence. Indeed, an estimated 13% of pregnant women experience this disorder.

Part 2 will be published soon.

The researchers were Heather Bennett, Heather Boon, Sarah Romans and Paul Grootendorst. The above is a partially modified reproduction of their research. Also their references have been omitted for ease of reading.

Reference:

Bennett HA, Boon HS, Romans SE, Grootendorst P. Becoming the best mom that I can: women's experiences of managing depression during pregnancy – a qualitative study. BMC Women's Health 2007, 7:13 (11 September 2007). © 2007 Bennett et al., licensee BioMed Central Ltd.
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.