Becoming pregnant, giving birth and looking after a baby are a source of joy for many women, but some find that the experiences around having a child are overwhelmed by unhappiness.
Perinatal depression affects about a quarter of women, either before they give birth (antenatal or prenatal) or when they are caring their baby (postnatal or postpartum).
One mother experiencing symptoms told Dr Khalood Al Abri, who has researched the issue in Oman, that she lived “within the thoughts” she developed.
“Somehow after this depression came to me, I felt upset, even with my husband and so on,” the woman said. “In short, it brings me thoughts that take me to another world and I feel that I follow this idea … and go far beyond real life to exist there, so I get tired a lot, because basically I live within the thoughts.
“I mean, I was trying to hurt myself, hurt my husband, hurt my son, but I was resisting this thing.”
Many organisations supporting women with perinatal depression are highlighting the issue in May, which is designated World Maternal Mental Health Month.
Research suggests there may be a need to improve awareness of the condition in the Middle East in particular. Dr Al Abri, an assistant professor at Sultan Qaboos University in Muscat, found that many women, unless they or a family member have previously been diagnosed, are not familiar even with the concept of perinatal depression.
Cultural factors could play a part in stopping women from seeking help. Many young couples in the region live with the husband’s parents, which can make life harder for a woman if she has a difficult relationship with her mother-in-law, according to Dr Al Abri.
“Most of the time the mother-in-law has the control in the home,” she said.
“If there’s any arising conflicts between the wife and the mother-in-law, this increases the problems with the husband and the whole of the family. That’s a risk for developing postnatal depression.”
Around the world, perinatal depression tends to be more common in low and middle-income countries than in high-income nations, according to analysis by Dr Al Abri, who was awarded a doctorate by the University of Manchester in the UK for her research.
She found that about 27 per cent of women in Oman experience antenatal depression, while 29 per cent suffer postnatal depression. The prevalence of perinatal depression in some other countries may be even higher, with a figure of around 37 per cent recorded in Saudi Arabia.
Despite the high prevalence, Dr Al Abri identified that healthcare workers in Oman may not have the training or skills to recognise the symptoms or may be too busy dealing with the physical side of a mother’s circumstances to consider her mental health.
“When I interviewed these women, they said, 'We want to talk about this, we want to know more, but nobody is talking about this, so how will we know?',” she said.
Aside from family difficulties, including conflicts within the marriage, many issues may cause a woman to develop perinatal depression. These include a lack of social support, the stress of childcare, a long-term medical condition such as diabetes, poor sleep, exposure to second-hand smoke and a history of mental illness.
Just as there are varied causes for perinatal depression, so the condition may manifest itself in numerous ways. Low mood, sadness, irritability, feelings of hopelessness or guilt, and difficulty concentrating may be seen. A woman may lack interest or enjoyment in things that normally bring pleasure, have reduced appetite and feel exhausted.
A new mother with postnatal depression may neglect herself or her child, such as by not attending a vaccination appointment.
Separating symptoms from what is normal
Louise Howard, professor emerita in women’s mental health at King’s College London, said that many of the symptoms of postnatal depression were normal after having a child.
“For example having a baby wake up frequently will inevitably make parents tired – and many of these symptoms can be part of the 'baby blues' if they only last for a few days in the first week,” she said.
When symptoms persist, such as for more than a fortnight, and affect the woman’s quality of life and how she functions, she may have postnatal depression.
“Severe postnatal depression is much less common, but is associated with feelings of wanting to end one’s life. If she is feeling like she wants to die, it’s important to get help from a healthcare professional as soon as possible,” Prof Howard said.
A woman’s partner may be the first person to spot symptoms, and the person she turns to for help, “so an open and supportive relationship is key”, according to Dr Shweta Misra, a clinical psychologist at Aspris Wellbeing Centre in Dubai.
“It’s also imperative that partners remain alert to any warning signs, such as difficulty coping. Their continued support plays a vital role in a new mum’s recovery,” Dr Misra said.
Women who experience perinatal depression often do not recognise what is happening, Dr Al Abri said.
“They have difficulty concentrating, in expressing their feelings,” she said. “This is the time to talk with them, trying to let them know the partner or family member is here to support her and to assist with daily tasks.”
The partner can be important in ensuring that the woman sees someone suitably qualified to make a diagnosis, such as a GP, Prof Howard said.
“Depression is a mental illness that is not a weakness or something that a woman can ‘snap out of’, but with the right care and support most women will make a full recovery,” she said.
It can be helpful to reconnect with good friends, close family members and other new mothers, such as through postnatal support groups.
Friends or family can also help, Prof Howard said, by giving the woman time away from her baby so that she can do something enjoyable, like relaxing in the bath or taking exercise.
While the internet can provide a supportive online community, Dr Misra cautioned new mothers against using social media excessively.
“It can set completely unrealistic expectations of new mums, in addition to helping perpetuate feelings of inadequacy and loneliness,” she said.
As well as the clinics and hospitals in the UAE and elsewhere that offer support to women with perinatal depression, there are also support groups, many of which can be found online.