Overview of the Risk Factors for Perinatal Mental Illness
(saaay what – so many??)
Have you ever wondered about what “causes” perinatal mental illness? Why some people may develop the perinatal mental illness and others don’t?
Research shows that there is not one factor that causes a woman to suffer from perinatal mood disorders. It seems the convergence of biological, psychological and social (biopsychosocial) factors play a role in the prevalence of anxiety and mood disorders during the childbearing year. Hormonal and lifestyle changes plus the re-surfacing of past personal issues surrounding the emotional material of becoming a mother create a time period where women are more vulnerable to mood disorders (Ghaedrahmati et al, 2017; Kleiman & Wenzel, 2011; Kleiman, 2009; Puryear, 2007; Nonacs, 2006).
Listed below are some of the commonly acknowledged risk factors for a woman to develop a perinatal mental illness. For ease of reading, they are grouped into bio/psycho/social categories, but, as you can see, there is much overlap.
Biological / Psychological
A personal history of a mental illness in her lifetime, such as depression anxiety, PTS/PTSD, OCD or bipolar disorder. These illnesses could have been diagnosed & treated or could have gone undiagnosed and left untreated.
Note that a mother who had a previous postpartum depression has a 50 to 80 percent risk of developing it again with her second baby (compared to a 10 to 20 percent chance without a prior episode)
A history of depression or anxiety disorders in the family, which may or may not have been diagnosed and treated.
Premenstrual syndrome/disorder. This woman might have a heightened sensitivity to her hormonal cycle, leaving her more vulnerable for her body to react to the hormonal changes of pregnancy & birth.
A heightened sensitivity to hormonal fluctuations of pregnancy and childbirth.
Traumatic birth. Traumatic birth can occur on a continuum from disappointing care to painful natural birth to actual life threatening complications for mom and/or baby during the birth.
Having a premature infant. Both the birth and the NICU experiences can be traumatic
A history of extensive infertility treatments, trauma from necessary medical procedures.
Unprocessed feelings around a previous pregnancy loss
Unprocessed feelings around a previous abortion
Having an infant with a disability
Having experienced a stillbirth
Social / Psychological
The lack of social support due to a geographical move, a non-supportive family structure (due to alcoholism or mental illness, etc), or due to a major change in job (ie, from career to SAHM, so the friend network is disrupted).
Lack of communication, differences in parenting styles, general disconnects, financial difficulties in the marriage/partner relationship are a high risk factor.
Poverty is a high risk factor for the development of perinatal mental illness.
Being in an abusive relationship – verbally, emotionally, physically abusive - which can be causal to a complex history of trauma/PTS/PTSD
A personal history of sexual abuse or sexual assault - which can be causal to a complex history of trauma/PTS/PTSD.
Unprocessed issues from childhood regarding parenting and being parented interferes with the transition to parenthood and can cause anxiety and depression. One wonders if one will be a good enough parent
Additional stressors, such as an accident or death in the family.
Previous occurrence of depression or anxiety a risk factor
The highest risk factors for developing a perinatal mood disorder are a previous occurrence of depression or anxiety in the lifespan, traumatic/chaotic childhood experiences, current poverty and lack of social support.
Childhood abuse and/or complicated childhood relationships a risk factor
In addition, unprocessed emotional material from childhood dynamics feeds into feelings of anxiety and depression after childbirth. It is harder to adjust to becoming a mother when the family of origin had a chaotic atmosphere caused by alcoholism, addiction, mental illness, rage, physical and verbal abuse. These unprocessed dynamics can cause feelings of inadequacy in parenting and over-concern about the psychological welfare of the baby and children, even if the parenting is loving and good enough.
Be proactive to prepare and prevent
The best way to prepare for postpartum depression is to be proactive.
Set up a social support network that you may have to put some effort into creating.
Reach out to one or two close friends and family.
Set up a meal plan.
Look into local food deliveries or make and freeze casseroles now.
Take care of your physical and mental health.
If you need to talk to a professional therapist, start the search for a compatible one now.
Look into medication. There is alot of research on medication and pregnancy now. There are some psychothrophic medications that research shows to be safe during pregenyc and breastfeeding. A great professional website with information is Mother to Baby.
References
Ayers, S. and Ford, E. (2009). Birth trauma: Widening our knowledge of postnatal mental health. European Health Psychologist, June, 2009, (11), p. 16 – 20.
Driscoll, D. and Sichel, J. (1999). Women’s moods: What every woman must know about hormones, the brain, and emotional health. New York: HarperCollins
Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Ebrahimi, A., & Bahrami, M. (2017). Postpartum depression risk factors: A narrative review. Journal of education and health promotion, 6, 60. https://doi.org/10.4103/jehp.jehp_9_1
Kleiman, K. (2009). Therapy and the postpartum woman. New York: Routledge Press.
Nonacs, R. (2006). A deeper shade of blue. New York: Simon and Schuster.
Puryear, L. J. (2007). Understanding your moods when you’re expecting. New York: Houghton Mifflin Company.
Zeng, Y., Cui, Y. & Li, J. Prevalence and predictors of antenatal depressive symptoms among Chinese women in their third trimester: a cross-sectional survey. BMC Psychiatry15, 66 (2015). https://doi.org/10.1186/s12888-015-0452-7