How long is the sad and sometimes dramatic trail of perinatal depression? How long can mothers be at greater risk of making extreme gestures? There is one international study published on Jama Network Open which tries to answer these questions by adding some light on such a dark phenomenon.
The study we are talking about has in fact shown that women who are diagnosed with perinatal depression (that is, which appears during pregnancy or after giving birth, which includes the older concept of depression post partum and which concerns between 10 and 20% of mothers) have a rate of suicide, both attempted and completed, approximately three times higher than that found among women without diagnosis during the first year after giving birth, and which – this is new from the study – the suicide risk is still present 18 years after the birth of the child. And 18 years is a really long time.
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Research on data from 90 thousand women
The research was conducted in Sweden by comparing the data of just under 90 thousand women diagnosed with perinatal depression, with a sample of over 86 thousand other women with similar demographic data but not suffering from depression. The average age of the entire sample of women is around 30 years and the suicides and attempted suicides were mostly carried out by poisoning and hanging.
“Suicide represents the second cause of death for women who become mothers and is particularly high during the first year after giving birth and even higher in the first 40 days after birth. This is a period of particular biological vulnerability, for the sudden drop in hormonal values”, says the psychiatrist Nicoletta Giacchettiwho together with the psychiatrist Franca Aceti manages the Perinatal Psychopathology Service of the Policlinico Umberto I-Sapienza University of Rome ([email protected])
“The data relating to the increase in suicidal risk after giving birth was already known in the literature, but this work has the merit of having observed and confirmed it on a very large sample of mothers and using a follow up of 17-18 years”, he adds Jackets. And he also tells us that these women’s period of vulnerability is much broader than we think.
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“The novelty concerns the observation that these women diagnosed with perinatal depression, 18 years after giving birth, still have a higher suicidal risk than the others. Therefore, women diagnosed with perinatal depression should be followed for long periods: it is not of months. In fact, we are talking about fragile personalities who are affected by the transition to parenthood with difficulty, and who may also need to be supported during their children’s growth process. In our centre, we too have followed some cases for years”, he explains still the expert.
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Indeed, the authors of the study on Jama Network Open conclude their work by saying that there is “a need for vigilant clinical monitoring of this vulnerable group”.
Motherhood as a redefinition of identity
Women who have no psychiatric history diagnosed before pregnancy are paradoxically less at risk than those with a disorder that had already emerged before pregnancy. Is that so? “It seems like a paradox but the fact is that generally women with a diagnosed disorder, even if not necessarily of a depressive type, arrive at maternity hospital already followed by a specialist, or in any case in the care of a health service. For women without a psychiatric history, motherhood can facilitate the unraveling, i.e. the emergence, of an emotional disorder that reveals hitherto unknown vulnerability factors, which interfere with the process of redefining one’s identity that accompanies the birth of a child”.
Risk and protective factors
Perinatal depression, like all psychiatric pathologies, is affected by biopsycho-social risk factors, that is, it involves biological factors (hormones and genetic vulnerability, for example), individual mental functioning and the socio-relational context in which these people live. But having said that, if you wanted to outline an identikit of these women, what would it be? Giacchetti: “Mothers at risk of depression are often single women, with economic difficulties, in whom childhood experiences of neglect, traumatic dimensions and conflicts with both the family of origin and the partner prevail.”
Signs to watch out for
The signs that could point to perinatal depression are insomnia, irritability, anxiety about the baby’s health, feelings of guilt and inadequacy. What to do when these signs actually appear? “When we realize that a pregnant woman or a new mother presents symptoms indicative of distress, it is advisable to contact structures dedicated to mental health that work in networks with consultants, for the recognition and management of these cases”, he says Jackets.
The myth of mater felix and social stigma
There is a stigma around these situations: depressed new mothers still fear social shame for not being as happy as a mother should be. Well, are things still like this or has the myth of the mater felix at all costs waned? “The stigma is still strongly rooted in society: there is a fear of being judged even within the family. Sometimes the family members themselves tend to minimize the woman’s discomfort and the reluctance to turn to dedicated centers can also arise from the fear of an intervention by social services which they are not considered as a support for parenthood. We must try to create a shared culture in which the psychological distress of women facing motherhood – concludes the psychiatrist – feel free to express their experiences, trusting in a society that supports and does not judge”