What are the Risk Factors for Developing Postnatal Depression?

There are many possible risk factors for developing postnatal depression. Some women will be exposed to more than one, which increases their chances of developing the condition. However, this is not always the case and many women who are exposed to multiple risk factors never go on to become postnatally depressed.

Risk factors can be categorised under the following:

• Physical
• Psychological
• Environmental.

Physical Risk Factors

A sudden drop in the hormones oestrogen and progesterone are thought to be a major contributing factor in the onset of postnatal depression. Both hormones surge during pregnancy but then begin to drop before birth in order for labour to begin. After the birth of the baby, the levels can drop dramatically and this is what is thought to cause ‘baby blues’. However, when women are very sensitive to changes in hormone levels, this means that their levels may not return as quickly to pre-pregnancy levels and this is what is thought to trigger postnatal depression to start.

Additionally, if someone has had a difficult birth, this can mean that their physical health in the wake of the birth is not as good as usual. Many women experience extreme fatigue in the early days after giving birth, but when accompanied by a lack in mobility due to a difficult birth, it can cause women to feel helpless, which can be a contributing factor in postnatal depression.

Caesarean sections

Women who undergo a caesarean section are thought to be at increased risk of postnatal depression because of the physical and psychological effects that it has on the mother. Up to 25% of women in the UK have a baby via this method and, since it is classed as major surgery, the recovery time can be a lot longer than by giving birth naturally. Many women who have had a caesarean struggle to be as active as they were before their operation and many will feel intense guilt at not giving birth naturally, especially if the procedure was carried out as an emergency.

Difficulty breast feeding

Many women who find it difficult to breastfeed their baby can also develop feelings of failure and inadequacy, and when added to other physical factors such as exhaustion, this can be debilitating on their ability to care for their baby. This can develop into a cycle where their feelings of hopelessness get worse.

Physical issues with the baby

Physical issues that affect the baby can also be risk factors for postnatal depression. If parents are unaware that their baby has got a disability before it is born, then this can be extremely shocking and can lead to feelings of guilt and disappointment because they can feel as though they have failed their baby. These are also issues for women who have had premature births and women whose babies have developed an illness soon after birth and so have to be placed in a special care unit, which reduces the chances for them to bond.

Psychological Risk Factors

Previous mental health

If a woman has had a previous experience of postnatal depression, this is thought to raise her chances of developing it again after subsequent births. Also, women who have incidents of other types of depression are also thought to be at increased risk of experiencing postnatal depression.

Women who have experienced other types of mental illness are thought to be at increased risk of postnatal depression, which may develop more rapidly than in women who do not have other mental health issues. This is thought to be linked to fluctuating hormone levels and the effect that they have on brain chemistry, which regulates moods.

There are lots of different types of medication for mental health problems, for instance there is more than 1 type of anti-depressant. Each have slightly different ingredients or doses, as medical advances happen more medication will keep coming out. Like all medication, people can get side effects from them or one type of medication may not agree with them where as another will.

Environmental Risk Factors

There appears to be more environmental risk factors of developing postnatal depression than any other. This is possibly because a woman’s ‘environment’ encompasses many aspects of her life.  For example, if she lacks social support or has a poor relationship with her partner this can lead to postnatal depression because she may feel overwhelmed with responsibility and be unable to cope.

If she is currently undergoing stressful life events this can also be a contributing factor. This is because caring for a new baby can be all-consuming and having other stressful things to worry about as well can also lead to feelings of being overwhelmed.

Some women may have previously had little experience of caring for a baby and this may make her feel inadequate and like she is floundering, unsure if she is doing the right thing. This can be made even worse by other women who seem to be able to adapt to motherhood with ease, even though those women may be experiencing exactly the same feelings of inadequacy privately.

Isolation

Isolation becomes a risk factor for some women, especially if they live a long way from their family and they do not have many friends in the same area. Caring for a baby can be a job that takes up a lot of time and leaves little time for the mother to have time for herself, and if she does she may feel too exhausted to do anything anyway. This can lead her to be detached from her own social network, especially whilst she is on maternity leave from work, leaving her with little adult contact.

Resentful

Some women become very resentful at being cut off from their adult world and these feelings can be exacerbated if they have given up work for good to care for their baby. Giving up work can also lead to worries about household finances, which can also be a contributing factor in the onset of postnatal depression.

Additionally, if someone has had a difficult birth, this can mean that their physical health in the wake of the birth is not as good as usual. Many women experience extreme fatigue in the early days after giving birth, but when accompanied by a lack in mobility due to a difficult birth, it can cause women to feel helpless, which can be a contributing factor in postnatal depression.

What is the difference between baby blues and postnatal depression?

Baby Blues

Experienced by approximately 80% of mothers in the 3-4 days following childbirth.

Many women may mistakenly believe that they are experiencing postnatal depression when, in fact, they have something that is commonly referred to as ‘baby blues’. Baby blues is thought to occur because of the massive change in hormone levels following childbirth.

Conversely, some women may believe they have baby blues when they are experiencing postnatal depression. This can lead to them believing that what they are experiencing is normal and this stops them from seeking treatment.

Symptoms:

• Weepiness or crying for no apparent reason
• Feeling unlike their familiar self
• Impatience
• Irritability
• Frustration
• Anxiety
• Rapid mood changes
• Poor concentration
• Sleeping problems.

Postnatal Depression 

Experienced by approximately 10% of mothers, and can be diagnosed up to two years after childbirth.

Postnatal depression is a condition that is thought to affect up to 1 in 10 women after the birth of a child.

The signs and symptoms of postnatal depression are similar to other types of depression and can lead to many women struggling to look after both themselves and their baby. Sometimes the cause of postnatal depression can be identified but sometimes it cannot, which can often make it difficult to treat.

Symptoms:

• Loss of appetite
• Insomnia
• Extreme anxiety
• Feelings of worthlessness
• Intense fatigue and irritability
• Loss of interest in previously enjoyable activities
• Confusion
• Self-neglect
• Loss of sense of humour
• Feelings of guilt and inadequacy about their ability to care for their new baby
• Problems bonding with the new baby
• Loss of interest in sex
• Extreme mood changes
• Withdrawal from family and friends
• Thoughts of self-harming or harming the baby.

Clearly, there is some crossover between the two conditions, which is why it can be very difficult for some women to understand which one they may have. Support from health professionals should enable them to identify any problems that they have following childbirth and many will be aware if they have any significant risk factors for postnatal depression whilst they are pregnant.