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Action needed to identify depression in new mothers

Depression is more common in first-time mothers when the child is four years old than at any time during the 12 months after giving birth, according to a new study.

Research carried out in Australia has shown almost one in three first-time mothers reported depressive symptoms at least once between pregnancy and four years after giving birth.

But the study found depressive symptoms were more common four years after a first birth than at any time during the first 12 months of a baby’s life.

“Current systems of maternal mental health surveillance will miss more than half the women experiencing depression in the early years of parenting”

Hannah Woolhouse

The study − published in BJOG: An International Journal of Obstetrics and Gynaecology − used data from 1,507 first time mothers registered to give birth at six hospitals in Melbourne, Australia, who completed questionnaires at three, six, 12, 18 months and four years after giving birth.

Women with only one child at four years after birth showed significantly higher levels of depression than women with two or more children.

The strongest predictor of depressive symptoms at four years post birth were having previously reported depressive symptoms either in early pregnancy or in the first 12 months after childbirth.

Other factors associated with depressive symptoms were being young − 18 to 24 years old − stressful life events in the year before the four year follow-up, violence from a partner or a low income.

But at four years after giving birth, 40% of women reporting depressive symptoms had not previously reported this.

The authors of the report said the findings presented a “compelling” case for a rethink on approaches to monitoring maternal mental health where policies focus on pregnancy and the early months after birth.

Hannah Woolhouse

Hannah Woolhouse

Study co-author Dr Hannah Woolhouse, a psychologist and senior research officer from the Murdoch Children’s Research Institute in Victoria, said: “It is likely that current systems of maternal mental health surveillance in Australia and the UK will miss more than half the women experiencing depression in the early years of parenting.

“In particular, women who do not have subsequent children may be especially vulnerable to falling through the gaps as they will not be reconnected back into primary care services,” she said.

“There also needs to be a focus on social health and relationships as we have found a strong link between depressive symptoms and intimate partner violence,” she added.

“Maternity services are failing women affected by mental health problems repeatedly”

Janet Fyle

Janet Fyle, professional policy advisor at the Royal College of Midwives, highlighted the need for better identification and appropriate referral of women with mental health issues relating to the birth of a child.

She said. “This research highlights that maternity services are failing women affected by mental health problems repeatedly and this leads to unnecessary suffering and distress for women and their families.

“We know that this is a high priority for midwives and maternity staff and it is clear they want to deliver a high quality service. They are often prevented by doing this either by the system itself or a simple lack of resources, such as midwives and specialist mental health midwives,” she warned.

Ms Fyle noted that Health Education England’s new mandate included an aim to improve midwifery training around perinatal mental health, and that the government had promised to improve postnatal services for women with mental health problems.

“However, we now need to see their words become deeds and their promises become significant action by way of better mental health care for women,” she said.

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