Everyone hears about postpartum depression, but what about postpartum anxiety?
While tragedies such as infanticide and suicide due to postpartum depression are exceedingly rare, these heart-breaking stories stick out in people’s minds and have led to increased awareness and screening by physicians.
In reality, postpartum anxiety is more than three times more prevalent than postpartum depression. The postpartum period creates increased vulnerability to developing generalized anxiety disorder (GAD). Though worrying during the perinatal period is normal, excessive or uncontrollable worrying may suggest postpartum anxiety. Postpartum anxiety and postpartum depression can occur concurrently, but some experience postpartum anxiety in isolation.
Despite estimates that 15 to 20 per cent of new mothers will develop postpartum anxiety, there is no routine screening. Furthermore, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, does not have standardized diagnostic criteria for postpartum GAD. The under-recognition is further complicated by symptoms that are difficult to differentiate from normal parental adjustment after birth. For example, physical symptoms of postpartum anxiety include fatigue, irritability and sleep disturbances that are typical of the postpartum population.
Women with postpartum anxiety most commonly report perinatal-themed worries such as not being a “good enough” mother and concerns about others’ judgments of their parenting abilities. These women often are invalidated as their anxiety is usually brushed off as normal maternal worries, creating a significant barrier to diagnosis and contributing to stigma surrounding maternal mental health.
Women’s anxiety is usually brushed off as normal maternal worries.
But postpartum anxiety is not the same as general adjustment challenges. It significantly impacts the mother’s functioning and quality of life. Mothers with postpartum anxiety are less likely to breastfeed their infant; issues with mother-infant attachment also have been reported. More severe consequences include increased risk of infant abuse, delayed development in infants and the possibility the child may develop anxiety later in life. Suicide and infanticide can also occur if postpartum anxiety is left untreated.
Within our health-care system, the burden of disclosing concerns is placed on the patient, a model that is effective for many health issues. But not for postpartum anxiety. In relation to postpartum anxiety, the majority who recognize that their symptoms are disruptive will not report it to a health-care provider.
Thus, screening for postpartum anxiety should be considered a vital part of quality obstetrical care. The lack of screening, diagnosis, treatment and research on postpartum anxiety is a disservice to the maternal population. Focusing solely on postpartum depression creates a gap in maternal health care. Given the many visits with health-care professionals in the postpartum period, there is ample opportunity to improve screening for postpartum anxiety.
Even when postpartum anxiety is properly diagnosed, the postpartum period poses unique challenges to treatment. Cognitive behavioural therapy (CBT), generally the first-line treatment for GAD, has not been extensively studied in the postpartum population. Many mothers are hesitant to try pharmacological therapies if they are breastfeeding.
To effectively support women in the postpartum period, population specific studies must be performed. Systemic changes in health care are needed to better protect and serve the vulnerable population of postpartum mothers.