Don’t dismiss signs of postnatal depression as weakness

Better screening of mums with newborns has picked out more who have postpartum depression, said Dr Cornelia Chee, senior consultant and head of the National University Hospital’s (NUH) Department of Psychological Medicine.

But better recognition of the symptoms and knowing how to access specialised help services are needed to prevent the devastating effects of the condition, she said.

Worrying symptoms could include intense anxiety or emotional volatility, and be caused by factors like intense marital or interpersonal tension.

“Usually, it is better if the mother herself recognises the symptoms (and many do), but at times, if she is in denial or underestimating the impact of the symptoms on her, the family should step in,” said Dr Chee. “Doctors can also play a part by being proactive and ask about mental health struggles – this could be her family doctor, obstetrician or even the paediatrician looking after her baby.”

There were at least 47 cases of depression, as well as anxiety and depression, registered in 2022 at NUH, a significant increase from an average of 25 cases per year between 2020 and 2021. 

Dr Chee said this rise can be largely attributed to the increased support and outreach provided to mothers by the hospital’s Women’s Emotional Health Service (WEHS) team, which supports women in Singapore facing emotional difficulties during pregnancy and in the first postnatal year.

WEHS is led by a multidisciplinary team of healthcare professionals comprising psychiatrists, psychologists, case managers and occupational therapists.

NUH also has a programme, started in 2008, that screens mothers-to-be in their first, second and third trimester, as well as postnatally for signs of depression. 

KK Women’s and Children’s Hospital (KKH) saw a 78 per cent increase in the number of patients who either had postnatal depression or difficulties related to adjustment to motherhood, not amounting to clinical depression, in the first half of 2023, compared with the same period in 2022. 

Dr Chua Tze Ern, senior consultant and head of KKH’s Women’s Mental Wellness Service, did not give figures but said these were patients who had undergone its postnatal depression screening programme, which began in 2008.

At the launch of Singapore’s first set of guidelines on perinatal mental health in February, KKH said that it had seen a significant rise in postnatal depression cases during the pandemic.

With the guidelines, it hoped to push for greater awareness of maternal mental health beyond the usual four to six weeks after birth, when clinicians are on the lookout for postnatal depression.

Meanwhile, over 1,600 KKH patients have been screened for antenatal depression, or depression during pregnancy – which increases the risk of postnatal depression – since December 2022. Over 8 per cent were found to have significant depressive symptoms.

A depressed mum is not just one who shows classic symptoms, such as low mood and easy tearfulness. She can avoid or withdraw from her baby, family and loved ones, or even exhibit anger and irritability, said Dr Chee. 

Besides offering non-judgmental support both emotionally and practically, family and friends can stay vigilant of the new mother’s moods, especially if she is persistently low, withdrawn or irritable beyond two weeks, and seek professional help if necessary, she said. 

A trained professional will be able to tell the difference between simple baby blues, such as feelings of frustration and anxiety about coping with a baby, and more serious conditions such as adjustment disorder or clinical depression or anxiety, and advise accordingly.

Many factors contribute to antenatal and postnatal depression, often in a complex interplay, said Dr Chua. For instance, having a personal or family history of depression may have contributed to a difficult childhood and affected the woman’s relationship with her own parents.

“Sometimes, this gives rise to old, unresolved emotional conflicts being awakened as she tries to figure out parenthood, or she may have personality traits that increase the risk of depression, such as being overly perfectionist or pessimistic.”

Many mothers here also practise a confinement routine in the first few postnatal months. Some may feel overwhelmed when it is time for the confinement provider to leave, while others may have unpleasant confinement experiences and feel judged and inadequate as a result, she said.

Dr Chee noted: “In general, if the symptoms are mild, and last less than two weeks, there is no need to seek help. 

“The problem is usually with mothers with moderate symptoms and distress... There is very little way to predict if or when they could get worse.”

It would be better, then, to seek help from a professional who would have a whole suite of medical support available and access to an emergency department and psychiatric ward if necessary, she said.

Dr Yang Liying, a consultant in the Department of Obstetrics and Gynaecology at Singapore General Hospital, said educating the public that postnatal depression is a common medical condition, and not a weakness or reflection of inadequacy, as well as better access to community mental health services and support helplines are some ways to help mums with postnatal depression.

Postnatal depression does not just affect a woman and her ability to care for her child. Many studies have shown that women with postnatal depression are likely to have children who are at higher risk of anxiety and depressive disorders later on in life, Dr Chee said.

Screening these children can be challenging. Dr Chee said it would require long-term follow-ups, given that these mental conditions tend to present only several years later when the child is in kindergarten or older.

Recognising maternal depression

Depression is one of the most common maternal mental health conditions and is characterised by the following symptoms:

• low mood or irritability;
• loss of interest or pleasure in activities;
• sleep disturbance unrelated to baby’s needs;
• unexpected changes in appetite or weight;
• poor concentration and memory;
• tiredness or fatigue;
• agitation or feeling “slowed down”;
• excessive self-blame or guilt;
• feelings of hopelessness and negativity about the future;
• thoughts of harming self or baby, and/or suicidal thoughts.

If these symptoms persist for over two weeks and affect a mother’s ability to carry out her normal activities, she should be encouraged to seek medical help.

Source: KK Women’s and Children’s Hospital