Down with the kids

Midwives magazine: Issue 1 :: 2012

More than 70,000 mothers across Britain suffer from postnatal depression each year, as a report from 4children has found that half of them suffer in silence, with far-reaching repercussions for themselves, their children and their families. The charity’s Attila Kulcsar reports.

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
Postnatal 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

References

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).