Three or more in 100 couples are affected by mood disorders such as anxiety or depression before or after the birth of their baby, a major study of the mental health of new parents in 15 countries has found.
Mothers and fathers are affected by these risks which extend beyond the first three months of an infant’s life, the researchers from University College London showed in a systematic review and meta-analysis of 23 studies.
Dr Simone Honikman, director of the Perinatal Mental Health Project in Cape Town, said the prevalence of perinatal depression and anxiety among women in lower- and middle-income countries, such as SA, seemed to be much higher than in higher-income countries.
“In SA, about one in three to one in five women will have depression and/or anxiety in the perinatal period. We have a dearth of paternal data in SA, but similarly, it is likely to be higher,” said Honikman, a public mental health professor at UCT.
The UK team analysed data from 29,286 couples over 21 years, reporting that perinatal anxiety and postnatal depression can affect mothers and fathers simultaneously, and that in about:
- two in 100 couples both parents experienced antenatal depression (1.7%) and early postnatal depression (2.3% up to 12 weeks after birth); and
- three in 100 couples both parents suffered late postnatal depression (3-12 months after birth).
Lead author Dr Kara Smythe, from the college’s Institute of Epidemiology and Health, described the burden of depression as considerable in both parents.
“Mood disorders in one parent may affect the other parent, and there is evidence that paternal depression leads to increased symptoms of depression in mothers during pregnancy and in the first six postpartum months,” she says.
“Parental perinatal mood disorders are associated with adverse pregnancy outcomes, impaired bonding with the newborn and behavioural problems in their children.”
Many of them did not grow up with their fathers and had no role modelling.
— Shuaib Salie, The Parent Centre
Developing a perinatal mood disorder was more common among mothers who endured psychosocial risks such as “early life stressors, limited social support and exposure to intimate partner violence”, the team noted.
“For fathers, the main factors associated with an increased risk of perinatal mood disorder were lower levels of education, unemployment, low social support and marital distress,” they found. Paternal anxiety tripled when the mother was depressed.
Women were three times more likely and men nine times more likely “to develop postnatal depression if they had experienced depression in the months prior to the child being born”, the UCL team noted.
Despite the frequency of mood disorders among new parents, up to 40% of new mothers did not get a postnatal check-up six to eight weeks after giving birth, a recent study found. Men had no such check-up scheduled.
Shuaib Salie, senior fatherhood trainer at The Parent Centre in Cape Town, said he had not had cases of fathers with depression, but stress over fatherhood was common.
“A lot of fathers are concerned about how they will support their child and how they will manage with their parental responsibilities.
“Many of them did not grow up with their fathers and had no role modelling in how to parent a child,” said Salie.
Debbie Meyer, the centre’s parent-infant attachment counsellor, has worked with mothers from disadvantaged circumstances in Mitchells Plain, some struggling with depression whom she has referred for medical care.
“In my area in Tafelsig some mothers have been disadvantaged in their childhood, upbringing, education and been abused,” says Meyer, who has been working there for 18 years.
“Once I had a girl who was as young as 16 with her second child and she said: ‘Auntie Debbie, if it were not for you speaking [at the clinic] I would have gone out and laid down on the railway line.’”
Mutually reinforcing and difficult socioeconomic circumstances in SA are likely to be driving the risk of depression among pregnant women, new mothers and fathers, in Honikman’s view. She called for greater government investment in perinatal mental health services which are widely available.
“The reason for the higher prevalence [of depression] in our settings is that mother are often facing multiple, coinciding risk factors such as poverty, food insecurity, violence and dysfunctional gender relations,” she said.
The perinatal mental health expert said solutions to support the mental health of new parents should tackle “both the mental health concerns and the socioeconomic determinants” in their lives.
The UCL researchers also recommended that the postnatal care model be updated “to focus on social determinants and relationships between expectant parents to identify couples at risk”.
They urged that a family-centred approach be adopted which offered better clinical care after the first three months of birth to mothers and fathers.
“I can see men who are depressed and women and teens with postnatal depression,” says Meyer. “I try to get the right people on the programme and I speak from the heart.”
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