Millions of children have their life chances diminished by growing up in
families facing serious challenges without practical support to prevent
problems from escalating into crises. It is increasingly accepted that,
with the right help early on, many such crises could be prevented. Yet
the huge culture shift we need to move from dealing with the
consequences of failure to widespread early intervention and prevention
is still a long way off. That is why 4Children launched the Give Me
Strength campaign in May 2011.
As part of this, 4Children took an in-depth look at
postnatal depression – a major cause of family instability and child
vulnerability. We found that: many families are suffering the
consequences of postnatal depression in silence; that if and when they
do seek help, mothers are not getting swift access to the range of
treatment options they need; and that this is having a detrimental
effect on families across Britain.
According to the World Health Organization, the
effect of depression on ability to function is 50% more serious than
angina, asthma, arthritis or diabetes (Moussavi et al, 2007).
There are 700,000 births in England and Wales each
year (ONS, 2011) and at least one in ten mothers are likely to suffer
from postnatal depression (Royal College of Psychiatrists, 2011).
Problems in pregnancy or birth, sleep deprivation and changes in
lifestyle and relationships are all triggers. It is a huge problem, not
only because of the impact on the mother but because maternal depression
can take a toll on families, sometimes leading to relationship
breakdown, family conflict, older siblings looking after babies, and
children living with the long-term consequences of poor early bonding.
Postnatal depression is a condition around which a
number of myths have grown: that it is less severe than other forms of
depression; that it is caused entirely by hormonal changes; and that it
will go away by itself. For some mothers, all three statements can
possibly reflect their experience, but, for most, postnatal depression
requires some form of treatment.
Ignorance isn’t bliss
4Children’s report, Suffering in silence
highlights a chronic lack of awareness of the symptoms of postnatal
depression and, for many mothers, a fear that admitting symptoms will
constitute an admission of failure or have serious implications for
their child. A survey of more than 2000 mothers (commissioned for the
report from Bounty in 2011) showed that 49% of mothers who believed they
had suffered from postnatal depression had not sought professional
treatment (see diagram). That represents 35,000 mothers and their
families suffering in silence each year.
The sooner a mother with postnatal depression gets
help, the less damaging it will be for her and her family, but early
treatment depends on being able to recognise the condition.
A recurrent theme of the report is insufficiency of
information – at all levels. Freedom of Information requests to primary
care trusts nationwide revealed a profound lack of information about the
prevalence, severity and treatment of postnatal depression. NHS chief
executive Sir David Nicholson admits that the ‘Department of Health and
NHS Direct do not hold national data on postnatal depression’.
The report also found that guidance from NICE on
treatment options was not being followed consistently. All too often,
mothers were prescribed antidepressants by GPs who were not aware of the
full range of local support available. Many mothers who were
dissatisfied said they had wanted access to counselling, as well as the
‘social’ support offered by children’s centres.
Pregnancy and birth means regular contact with
midwives, GPs and health visitors, so the main elements of a system that
can identify and provide quick access to services for postnatal
depression are already in place. Yet many mothers slip through the net,
either unable to diagnose their symptoms or to locate help.
Don’t forget fathers
depression can affect men directly, and midwives can play a crucial
role in helping families recognise and seek help for paternal
depression. A total of 11% of respondents felt their partners should
have been provided with medical treatment or counselling.
Paternal depression has a direct influence on the
way fathers interact with newborn infants, making them less responsive.
In addition to the effect on their own wellbeing, partners suffering
from depression will be less able to support and nurture mothers and
other children in the family. Some 43% of mothers said their partners
could have been more supportive if they’d had more information.
4Children is calling for midwives, health visitors
and GPs to help normalise attitudes to postnatal depression and remove
the taboos that can hinder attempts to seek support; to provide more
information about local support groups and counselling therapies in
locations such as children’s centres – backed up with practical
assistance when needed. Failure to deliver this change means more
unnecessary suffering. We cannot afford to do nothing.
Read the full report: www.4children.org.uk/resources/detail/suffering-in-silence
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370(9590): 851-8.
Office for National Statistics. (2011) Births and deaths in England and Wales in 2010. See: www.ons.gov.uk/ons/rel/vsob1/mortality-statistics--deaths-registered-in-england-and-wales--series-dr-/2010/stb-deaths-by-cause-2010.html (accessed 22 January 2012).
Royal College of Psychiatrists. (2011) Postnatal depression. See: www.rcpsych.ac.uk/mentalhealthinfoforall/problems/postnatalmentalhealth/postnataldepression.aspx (accessed 22 January 2012).