Breaking the Silence: Encouraging Help-Seeking for Postpartum Depression

Witnessing the arrival of a newborn into the world is often regarded as a moment of pure joy and fulfilment for a mother. The air seems to hum with positive emotions, and one can almost hear the collective sighs of relief and excitement. But could there be something lurking behind this wonderful scene? According to McIntosh (1993), a renowned researcher from Glasgow University, the journey into motherhood is not always smooth. It can be marred by unexpected emotional challenges that cast a shadow on this otherwise blissful moment. The fact that Nemours Child Health Organization (2020), a leading pediatric research and clinical research institute, underlines that a new mother whose heart is filled with love and curiosity and wrapped in a precious bundle of joy can still hide a concern under her radiant smile; the demands of caring for a newborn, coupled with the fatigue that mothers experience, can add to their increased stress. Nemours Child Health Organization (2020) adds that most new mothers experience anxiety, sadness, frustration, exhaustion, and stress during the first few weeks of caring for a newborn. But what if these feelings refuse to fade away? What if they persist, casting a dark cloud over the mother's ability to care for her infant? This is where the term "postpartum depression" comes in. Psychiatrists Moses-Kolko and Roth (2004) shed light on this silent struggle, revealing that postpartum major depression is not only the most common complication of childbirth but also the prevailing perinatal mood. Behind the fairy tale narrative of motherhood lies a fascinating tale of strength, resilience, and vulnerability. This article will cover the story of mothers who face emotional warfare that society often cannot accept. As this hidden world is browsed, the true complexity of the human experience will begin to be understood.

Figure 1: Never Stop Growing (Stephenson, n.d.)

Understanding Postpartum Depression: A Multifaceted Interaction

To begin with, it is necessary to understand what postpartum depression is and its causes. According to Mayo Clinic (2022), a nonprofit organization committed to clinical practice, education, and research, postpartum depression (PPD) is a complex and multifaceted condition that manifests in women following childbirth, encompassing a range of symptoms such as persistent sadness, despondency, and diminished interest in once pleasurable activities. In addition, Mayo Clinic (2022), stated that PPD's etiology is thought to stem from an intricate interplay of physiological, psychological, and social factors. Physiologically, hormonal fluctuations, notably the abrupt decline in estrogen and progesterone levels postpartum, may disrupt neurotransmitter systems implicated in mood regulation, particularly serotonin (Mayo Clinic, 2022). Concurrently, the physiological stressors of sleep deprivation and physical recovery from childbirth further contribute to the emotional vulnerability experienced by new mothers (Mayo Clinic, 2022). Additionally, psychosocially, preexisting mental health issues, including a history of depression or anxiety, act as significant risk factors for PPD (Mayo Clinic, 2022). Moreover, the absence of robust social support systems, strained relationships, financial stressors, and previous exposure to traumatic life events amplify the susceptibility to developing PPD (Mayo Clinic, 2022).

Decoding the Nature of Postpartum Depression

According to researchers in the field of the nursery from McMaster University, Sword et. al (2008), postpartum depression affects up to 15% of new mothers. Interestingly, it is not culture-specific; instead, it is a negative outcome of delivery that affects women of all cultures. In addition, postpartum depression can significantly affect the woman and her baby, partner, and other children (Sword et. al, 2008). Women who suffer from postpartum depression have a hard time attaching to their babies, are less sensitive to their needs, and may have unfavorable views toward their babies (Sword et. al, 2008). According to researchers in the field of psychiatry, Dennis, and Chung-Lee (2006), unfortunately, postpartum depression can impair a woman's physical and social functioning and cause marital stress, leading to divorce or separation. While the effects are severe, only a tiny percentage of women with depression receive professional help (Dennis, and Chung-Lee, 2006). Dennis and Chung-Lee's (2006) research supported this: "Postpartum depression often remains undiagnosed and untreated. Even when health professionals detect it, women frequently do not obtain assistance" (p.324). McIntosh (1993) adds that only 26% of those who suffer from depression seek professional help. In brief, although many women experience this situation, they do not ask for help; they want to seek help, but they simply cannot.

Figure 2: Mothers and Mother (Stephenson, n.d.)

PPD and Help-Seeking: Unraveling Complexities Among Mothers

An attempt should be made to establish a behavioral intention to seek help for women with PPD. For this to happen, first, women's attitudes toward asking for help should be examined. According to researchers in the field of psychology, McGarry et. al (2009), most women with PPD from various cultures do not actively seek care. So, what are the reasons? First, the low knowledge of mothers on this issue may be one of the reasons. They may not be seeking any help because they do not know that PDD exists. An award-winning medical writer and communications expert, Bruce (2023) reported that PPD is a complicated mix of physical, mental, and behavioral changes that some women experience after having a baby. That is to say, the chemical, social, and psychological changes after having a baby are associated with postpartum depression, but these may not be known because they are complex (Bruce, 2023). Bruce (2023) added that many new mothers go through various physical and emotional changes due to their pregnancy and the signs and symptoms of postpartum depression can be challenging to detect. Furthermore, following childbirth, many women experience the following symptoms: Sleep disturbances, changes in appetite, extreme fatigue, lowered libido, and mood swings (Bruce, 2023). Also, even if they know the symptoms, it is not enough for them to seek help. According to Sword et al. (2008), women were deterred from seeking help because they normalized their symptoms, waited for symptom improvement, were uncomfortable addressing mental health concerns, and had anxieties and family and friends could sometimes obstruct seeking help because they normalized symptoms or had a limited grasp of postpartum depression. It is crucial to address the complex factors that influence help-seeking behaviors among women with postpartum depression. Increasing knowledge, raising awareness about symptoms, and dispelling the misconceptions surrounding postpartum depression are vital steps to encouraging mothers to seek the support they need. By fostering a supportive environment and providing accessible resources, women can be encouraged to overcome barriers and prioritize their mental health during this transformative stage of motherhood.

Figure 3: Self Love (Stephenson, n.d.)

Since it is interconnected, it is necessary to talk about the subjective norm. According to social psychologist Ajzen (1991), subjective norm refers to the perception of social approval or disapproval regarding the behavior in question. It has been seen that this factor has a significant impact on women's attitudes. According to a study conducted by researchers in the field of mental health by Habel et. al (2015), PPD symptoms were linked by some participants to women's inability to cope with the transition to parenthood, parenting demands, or the desire to be a 'good mother.' As mentioned before, subjective norms have to do with a person's ideas about whether her peers and other important individuals think she should engage in the conduct (Ajzen, 1991). McIntosh (1993) obtained interesting findings in his study directly with mothers where participants made the following statements:

I tried to tell my mother I was depressed, but she just says, “Och, I am depressed with you.” and I keep it to myself. I've given up saying to him (my husband). He thinks I'm just making a fuss about nothing. I'd rather go into my room and sit and cry myself. (p.181).

Unfortunately, this is an example of the social pressure experienced by mothers. Another finding from McIntosh's (1992) research is along the lines: A participant explained her fear of being labeled a ‘bad mother’ as follows:

I hold him, feed him, and change him, but I'm not happy, and I felt so horrible about it, and it was hard to admit to people because, you know, I was so frightened of being labeled a "bad mother," you know. And it was difficult for me to admit to my spouse that I'm not happy; I have this lovely baby, but I'm not happy. (1993).

As reported by professor of Media and Communication, Faulkner (2004), mothers are judged by society and their peers based on what they do and do not do, as well as what they think about mothering and being a mother. When this is the case, mothers may not feel comfortable to seek help.

Breaking Barriers: Empowering Help-Seeking and Treatment Awareness for PPD

According to researchers in the field of psychology, McGarry et al. (2009) state that after childbirth, women have a variety of interactions with healthcare specialists, yet often are hesitant to disclose depression. Additionally, researchers in the field of mental health, Habel et al. (2015) add that despite the effectiveness of existing therapies for PPD, multiple studies show that women with depressive symptoms are hesitant to seek help and deny a mental health referral. In summary, they do not even want to admit that they are depressed because of social and psychological factors, since they feel like they do not have control, their intentions are also relatively low (Habel et al., 2015). Research by Dennis and Chung-Lee (2006) reported that many mothers said they did not know where to go for help or were unaware of treatment options. Thus, it should be important to explain the treatment methods to the mothers because there is ignorance in this area (Dennis and Chung-Lee, 2006). The studies conducted by McGarry et al. (2009), Habel et al. (2015), and Dennis and Chung-Lee (2006) shed light on why women are reluctant to disclose and seek assistance for postpartum depression (PPD). Despite the existence of effective therapies, psychological and social factors, along with feelings of helplessness, contribute to their hesitancy and refusal to seek mental health support (Dennis and Chung-Lee, 2006; McGarry et al., 2009; Habel et al., 2015). Additionally, many mothers lack knowledge about where to find help or the treatment options available to them (Dennis and Chung-Lee, 2006; McGarry et al., 2009; Habel et al., 2015). To tackle this issue, it is crucial to educate mothers about available treatment methods and increase awareness, aiming to bridge the gap between women experiencing PPD and accessing the necessary support and care.

Figure 4: Take Time to Breath (Stephenson. n.d.)

Comprehensive Treatment Approaches for PPD

Finally, it is necessary to talk about treatment. What are the approaches used in the treatment of PPD? Researchers from the University of Toronto, Stewart, and Vigod (2016) emphasize that the treatment of postpartum depression (PPD) adopts a comprehensive and integrative approach, encompassing diverse therapeutic interventions tailored to individual needs. Stewart and Vigod (2016), suggested many different techniques including psychotherapy, specifically cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), which serves as a fundamental component of PPD treatment, enabling individuals to navigate negative thought patterns, enhance coping skills, foster interpersonal relationships, and establish support networks. In cases of moderate to severe PPD, medication, predominantly selective serotonin reuptake inhibitors (SSRIs), may be prescribed to modulate brain serotonin levels and alleviate depressive symptoms, with careful consideration given to breastfeeding mothers (Stewart and Vigod, 2016). Moreover, the critical role of social support is also underscored, with family, partners, and friends providing practical assistance, emotional understanding, and participation in support groups to foster validation and shared experiences (Stewart and Vigod, 2016). Furthermore, the promotion of self-care practices, including regular exercise, balanced nutrition, sufficient rest, and relaxation techniques, plays an integral role in managing PPD and nurturing overall well-being (Stewart and Vigod, 2016). Keep in mind that, collaboration with healthcare professionals is deemed essential in designing tailored treatment plans that recognize the unique circumstances of each individual, ensuring successful outcomes and facilitating the recovery process (Stewart and Vigod, 2016).

Conclusion

As a concluding remark, the challenges posed by postpartum depression (PPD) for new mothers necessitate a comprehensive and compassionate approach to treatment. A deeper understanding of the causes and nature of PPD can better support women in their journey of recovery. Help-seeking behaviors can be encouraged by addressing barriers such as limited knowledge, societal expectations, and fear of judgment. By raising awareness, providing accessible resources, and fostering a supportive environment, mothers can be empowered to receive the help they need. The hidden struggles faced by mothers with PPD should be recognized and acknowledged, allowing the stigma surrounding this condition to be broken and the mental health of new mothers to be prioritized. Through collaborative efforts as a community, a society can be created that supports and uplifts mothers, enabling them to navigate the challenges of PPD with resilience and strength.

Bibliographical References

Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50(2), 179-211.

Bruce, D. F. (2003). An overview of postpartum depression. WebMD.

Dennis, C. L., & Chung‐Lee, L. (2006). Postpartum depression help‐seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth, 33(4), 323-331.

Faulkner, S. L. (2014). Bad mom (my) litany: Spanking cultural myths of middle-class motherhood. Cultural Studies? Critical Methodologies, 14(2), 138-146.

Habel, C., Feeley, N., Hayton, B., Bell, L., & Zelkowitz, P. (2015). Causes of women׳ s postpartum depression symptoms: Men׳ s and women׳ s perceptions. Midwifery, 31(7), 728-734.

Mayo Clinic. (2022). Postpartum depression.

McGarry, J., Kim, H., Sheng, X., Egger, M., & Baksh, L. (2009). Postpartum depression and help-seeking behavior. Journal of Midwifery & Women's Health, 54(1), 50-56.

McIntosh, J. (1993). Postpartum depression: women's help‐seeking behaviour and perceptions of cause. Journal of advanced nursing, 18(2), 178-184.

Moses-Kolko, E. L., & Roth, E. K. (2004). Antepartum and postpartum depression: healthy mom, healthy baby. Journal of the American Medical Women's Association (1972), 59(3), 181-191.

Nemours Kids Health Organization. (2020). Postpartum Depression.

Stewart, D. E., & Vigod, S. N. (2019). Postpartum depression: pathophysiology, treatment, and emerging therapeutics. Annual review of medicine, 70, 183-196.

Sword, W., Busser, D., Ganann, R., McMillan, T., & Swinton, M. (2008). Women's care-seeking experiences after referral for postpartum depression. Qualitative Health Research, 18(9), 1161-1173.

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