Familial Risk of Postpartum Depression

Introduction

A baby's birth can be a beautiful experience for a mother. She may look forward to her journey of motherhood. The journey may be a mix of emotions, including excitement, immense happiness, and joy, and simultaneously overwhelming with anxiety and stress. In a few women, feelings of depression may also surface.

What Is Postpartum Depression?

Many new mothers experience "baby blues" after giving birth. They may have symptoms like mood swings, crying spells, difficulty sleeping, and anxiety. This starts on the second or third day of delivery and may last up to two weeks to months. These early symptoms are often overlooked as changes that occur in a new mother's routine after a baby's birth. Lack of knowledge is the major drawback that leads to worsening of symptoms. However, some mothers may experience a long-lasting and serious form of depression called postpartum depression (PPD). It is called peripartum depression if the symptoms start during pregnancy and continue after childbirth. In less common cases, a very severe form of mood disorder called postpartum psychosis may also develop.

What Are the Causes of Postpartum Depression?

The leading causes of postpartum depression are:

• Genetic Factors: It is believed that genetics plays a role in developing postpartum depression if there is a family history of postpartum depression or a major psychological issue.

• Physical Factors: After delivery, the levels of hormones like estrogen and progesterone, and thyroid hormones decrease. This results in tiredness, sluggishness, and depression.

• Emotional Factors: Emotional factors like lack of sleep and rest, overwhelming feelings, anxiety, and loss of identity and control over life can cause depression.

What Are the Risk Factors for Postpartum Depression?

The risk factors include:

• A history of depression during previous pregnancies.

• General depression.

• Bipolar disorder.

• History of postpartum depression in previous pregnancies.

• Family members with depression or mood disorders.

• Previous stressful pregnancies.

• A weak support system.

What Is the Familial Risk of Postpartum Depression?

Though a family history of psychiatric disorders can increase the risk in normal individuals, the exact connection between PPD and familial risk of psychiatric disorders is unclear. There is evidence that childbirth can increase women's risk of mental disorders. This occurs as childbirth is a significant life transition linked with physical, social, and emotional changes. Women can be diagnosed with the following conditions:

1. Postpartum depression.

2. Unipolar depressive disorders.

3. Bipolar affective disorders.

4. Adjustment disorders.

5. Schizophrenia.

6. Psychosis.

The most common postpartum psychiatric disorder women experience after a baby is born is postpartum depression. It is experienced by about 11 to 15 % of new mothers. PPD can start as early as a few weeks after giving birth and may last upto 12 months. Many mothers recover from PPD within a few months. However, some may experience it beyond one year of giving birth. Unfortunately, it has a detrimental effect on the mother, baby, and, sometimes, the entire family. The adverse outcomes of PPD include:

• Maternal mortality.

• Behavioral and cognitive problems in the child.

• A compromised mother-baby attachment.

EPDS (The Edinburgh Postnatal Depression Scale) is the screening tool employed to diagnose PPD. This tool identifies women who need further diagnostic evaluation and necessary treatment. Treatment includes antidepressant medications, regular home visits by a health nurse, cognitive behavioral therapy, and interpersonal therapy.

A family history of psychiatric disorders is a well-established risk factor for developing such disorders outside pregnancy and postpartum. However, family studies have shown an increased familial risk of psychiatric disorders in the postpartum period. For example, having a close relative with a history of postpartum mood disorder more than doubles the risk of developing a postpartum mood disorder. Also, PPD is more heritable when compared to major depressive disorder. Several other studies based on the other risk factors have also proven that a familial history of psychiatric disorders increases the risk of PPD. Though some studies suggest a solid link, a few other studies contradict the same and believe both may not be linked.

Though the exact reason for the link between familial risk and PPD is unclear, scientists believe that genetic and environmental factors, along with the mother's upbringing during her childhood, can have a role.

What Are the Significant Outcomes of Studies?

The various studies conducted to find the link between familial risk and PPD concluded that:

1. The risk of PPD was significantly higher in women with a first-degree relative having a history of PPD compared to a first-degree relative without a history of PPD.

2. Having a second or third-degree relative or a non-blood relative with a history of PPD was not associated with the risk.

3. In women with no previous psychiatric disorders, a strong genetic trait is not associated with PPD.

How to Help New Mothers Cope With Postpartum Depression?

Simple ways can help a new mother cope with the prolonged "baby blues." These include encouraging them to practice self-care as a part of their daily routine and seek social support during difficult periods.

• Self-Care: Specific lifestyle changes can significantly impact the well-being of new mothers and help them cope with PPD. Lifestyle changes that can be considered include:

• Making some time to relax.

• Getting sufficient sleep whenever possible.

• Eating a healthy diet.

• Spending time outdoors in the sun.

• Practicing a daily simple exercise routine.

• Self-pampering sessions like having a hot cup of tea, bubble baths, or listening to favorite music.

• Social Support: Like in other forms of depression, social isolation is common in postpartum depression as well. Women tend to isolate themselves from family and friends due to their state of mind. However, this only further worsens the situation rather than bettering it.

The other therapeutic options to help mothers cope include:

1. Psychoeducation.
2. Cognitive behavioral therapy.
3. Antidepressants.

Encouraging a new mother to stay connected with family and friends can help her. As they also experience fear and anxiety due to the new transition in their lives, a strong support system is paramount. A positive way to handle this is by encouraging a new mother to join support groups comprising many new mothers. Interacting on such platforms can ease their fears, anxieties, and depressive symptoms. Also, the spouse plays a vital role in giving the necessary physical and emotional support.

Conclusion

The postpartum phase can be beautiful and memorable in a mother's life. However, it can become difficult to tackle when anxiety and loss of control are overwhelming. A constant feeling of fear and hopelessness dooms. This phase of postpartum depression has found a strong connection with familial risk. Many studies believe that genetics has a role to play. Whatever the reason, a new mother supported during the initial phases can take good care of the baby and family in times to come.