Depression During Pregnancy – Part 2

Depression During Pregnancy - The potential side effect of many drugs having the ability to cause defects in a developing fetus and the behavioral impact of antidepressant use on the infant.

Despite the rapidly increasing quantitative literature on the clinical outcomes of maternal depression, little is known about pregnant women’s subjective experiences of depression. A review of the literature failed to reveal any publications exploring women’s experiences, feelings and perceptions of depression during pregnancy.

This is surprising given recent findings that major depressive disorder MDD is a leading cause of disease burden for women, the extensive exploration of women’s experiences of postpartum depression (PPD), and the current emphasis on disability due to mental health.

Given the intense concerns of women and their healthcare providers over possible teratogenicity (potential side effect of many drugs having the ability to cause defects in a developing fetus) and the behavioral impact of antidepressant use on the infant, the treatment experience of depression during pregnancy is likely to differ substantively from that of postpartum depression.

Furthermore, it has been suggested that there may be a “different biologic basis or vulnerability” to depression in pregnancy than in the postpartum resulting in different symptom profiles. Although existing qualitative literature exploring postpartum depression may have some relevance to the experience of depression in the prenatal period, there may also be differences between the two reproductive phases and extrapolation from one to the other is risky.

The aim of this research was to explore women’s experiences of depression during pregnancy and to develop a theoretical model for the processes they used to manage their depression. 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.

Understanding how the women view this disorder and its management has the potential to provide fresh perspectives for the delivery of care.

To understand the process of managing prenatal depression there must be an appreciation of the women’s experiences, comprehension of their understandings of the world in which they live, and an understanding of their moral judgments. Symbolic interactionists believe: 1) That objects have meaning only through people’s interactions with them in the environment, 2) That the meanings people have for things develops through social interaction, and 3) That those meanings are handled and modified by a constant and ongoing interpretive process by individuals.

Thus, symbolic interactionism provides a useful framework within which to study depression, a disorder “deeply connected with individual and collective interpretations”.

Data about the woman’s experiences of depression were collected through individual, in-depth, semi-structured, audio-taped interviews. Women were invited to propose the time and location of the meeting so that they would feel more empowered in the interaction encouraging them to share their experiences. Sixteen women elected to be interviewed in their own homes, the remaining three women were interviewed in a private room at the hospital.

Each interview began with the question “Can you tell me what it was like for you being depressed while you were pregnant”. This broad question served to “break the ice” leading to conversation that provided information on the woman’s views about depression, labelling, stigma, incidents contributing to her depression, her symptoms, the influence of depression on her relationships, her coping strategies, her experiences of help-seeking, and her feelings and beliefs about counselling and the use of antidepressants.

While the goal of the study was to obtain information in all areas, individual experiences of each woman dictated how much time was spent discussing each topic. Questions were asked to validate the women’s experiences and encourage them to show how they had reached particular conclusions. The final question was “Is there anything that we haven’t talked about that you would like to tell me or that you think I should know?”

To gain an awareness of the experiences described by the women, taped interviews were listened to immediately following each interview. The first four interviews were transcribed verbatim by Heather Bennett and the remainder by a professional medical transcriptionist. Heather Bennett verified, and corrected where necessary, all transcripts against the recordings.

Each transcript was read multiple times to gain familiarity with its content, to identify conceptual categories within the interview data, and to examine relationships between those categories.

Interview guide - core and probe questions, asked in semi-structured interviews, that pertain to the women’s depression experiences.

Can you tell me what it was like for you being depressed while you were pregnant?

• How did the depression affect your everyday life?
  
• What affect did it have on your relationships with your partner, children, family, friends or work colleagues?
  
• How did you make sense of the symptoms that you were experiencing?
  
• How would you describe the process of becoming aware that what you were feeling may have been depression?

Where there any events that you think contributed to your depressed mood?

• Did you experience any other issues like troubles with your job, money, or with family or friends at that time?


• How did those events contribute to your depression?

Before you went to see the doctor, what did you do about your mood and how you were feeling?

• Did you seek help or support from anyone? Was the support provided by that person helpful?


• What else did you do to cope with your mood? Did anyone comment on the way you were coping?


• What do you think would have helped you cope with your depression?

How did you make the decision to seek professional help for your mood?

• Did you have any concerns about going to your doctor about your mood?


• What were your expectations of the doctor?

What type of help did your doctor suggest for your depression?

• Did you take medication or have counseling for your mood while you were pregnant?


• How did you make that decision about that? Who or what information helped you make that decision?


• How hard was that decision?


• How did you feel about the way that your doctor helped you to manage/treat your mood?


• Did you wish that your doctor had managed/treated your depression differently?

How did you feel when you got the diagnosis of depression?

• What did that mean to you?


• Did you tell anyone? Who? Why/why not?


• How did you cope with this ‘label’?


• How did you change when you got the diagnosis of depression?

How has your mood been since the birth of your baby?

• How did your mood affect your attachment with your baby?


• How did your mood affect your sense of yourself as a mother?

Is there anything else that you would like to tell me or that I should know?

Part 3 will be published soon.

Related articles:

Dealing with Depression during Pregnancy – Part 1
Depressed? Drink Tea

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.