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Action Needed: Postnatal Depression

Xenia J. Kozlov


From the Very Beginning

When considering Adverse Childhood Experiences (ACEs), specialists usually assume childhood from the very beginning (0-7 years, according to Centers for Disease Control and Prevention [CDC]), or including prenatal period, but not relatively to generational (historic) trauma (CDC, n.d.). Scholars who make a research in terms of prenatal development find connection between mother’s ACEs and her postnatal depression, and then link it to the risk of ACEs for the child through the (lack of) attachment and the impact of ACEs on parenting style which, in its turn, affects child’s mental development (Luby, Tillman & Barch, 2019; Nguyen et al., 2019)..However, addressing intergenerational transmission seems to be comparatively new scientific research direction, while the connection might seem obvious, especially for mothers who experienced postnatal depression (regardless age, race or ethnicity) – that means, the problem should not be underestimated (Mersky & Janczewski, 2018). In the research of Ångerud et al. (2018), 58.6% of 1257 Sweden women who participated in study, reported at least one ACE category and 7% reported five or more ACE categories; authors warn postpartum depression reduce mother–child interaction, and this carries immediate and long-term risks and consequences for the development of the next generation, such as withdrawn behavior, less positive emotional state, reduced motor development and more insecure attachment.


Postnatal Depression Characteristics

Postnatal Depression, or PND (also, postpartum – PPD) is a debilitating mental disorder. Its distribution range is 5% - 60.8% worldwide. Mothers experience intensive feeling of inability, helplessness, and isolation. PPD is characterized by sleep disorders, mood swings, changes in appetite, fear of injury, serious concerns about the baby, much sadness and crying, sense of doubt, difficulty in concentrating, lack of interest in daily activities, thoughts of death and suicide (Ghaedrahmati et al., 2016). The relation between PND and breastfeeding was also described in literature (Brown, Rance & Bennet, 2016).

If described by CAB model, cognitive aspect of PND is impacted by factors related to behavioral changes, psychological specificity, and social exclusion. The lack of experience, education or knowledge; previous history of anxiety and/or depression episodes; finally, lack of sleep and deficit of cognitive control can literally ruin mother’s habitual lifestyle and mental health. The numerous requirements to mother, real and culturally conditioned, together with undervaluation of “baby blues” increase the level of vulnerability which also impairs cognition. Also, scholars name rumination and biases about motherhood among risk factors of woman’s cognitive state (DeJong, Fox & Stein, 2016).

The affective aspect of postnatal depression is usually related to hormonal changes but we should remember that biological state is closely tied to the lifestyle. Thus, lack of sleep was found as related to elevated cortisol levels and increased stress (Barry et al., 2015; Okun, 2016). Also, levels of serotonin, oxytocin and estrogen determine mood swings, anxiety, irritability, feeling lonely and guilty (Ghaedrahmati et al., 2017). As for behavioral changes, it can be characterized as totally different and usually undesired. Probably, the most important factors are marginalization and ignorance of woman’s personality due to the shift of the focus to baby’s health and safety. Also, such habits as smoking may increase chance for PND almost twice (Ghaedrahmati et al., 2017).




References:

Ångerud, K., Annerbäck, E.‐M., Tydén, T., Boddeti, S., Kristiansson, P. (2018) Adverse childhood experiences and depressive symptomatology among pregnant womenActa Obstetricia et Gynecologica Scandinavica, 97, 701– 708. Retrieved from https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.13327

Barry, T. J. et al. (2015). Maternal postnatal depression predicts altered offspring biological stress reactivity in adulthood. Psychoneuroendocrinology, 52. 251-260. https://doi.org/10.1016/j.psyneuen.2014.12.003.

Brown, A., Rance, J. & Bennet, P. (2016) Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing 72(2), 273–282. doi: 10.1111/jan.12832

Centers for Disease Control and Prevention [CDC] (n.d.). Adverse Childhood Experiences (ACEs). Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html

DeJong, H., Fox, E. & Stein, A. (2016). Rumination and postnatal depression: A systematic review and a cognitive model. Behaviour Research and Therapy, 82, 38-49. https://doi.org/10.1016/j.brat.2016.05.003.

Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Ebrahimi, A., & Bahrami, M. (2017). Postpartum depression risk factors: A narrative review. Journal of education and health promotion, 6, 60. doi:10.4103/jehp.jehp_9_16

Luby, J.L., Tillman, R. & Barch, D.M. (2019) Association of Timing of Adverse Childhood Experiences and Caregiver Support with Regionally Specific Brain Development in Adolescents. JAMA Netw Open. 2(9), e1911426. doi:https://doi.org/10.1001/jamanetworkopen.2019.11426

Mersky, J.P. & Janczewski C. E. (2018). Adverse Childhood Experiences and Postpartum Depression in Home Visiting Programs: Prevalence, Association, and Mediating Mechanisms. Maternal & Child Health Journal 22(7):1051-1058. doi: 10.1007/s10995-018-2488-z.

Nguyen, M. W. et al. (2019). Assessing Adverse Childhood Experiences during Pregnancy: Evidence toward a Best Practice. AJP reports, 9(1), e54–e59. doi:10.1055/s-0039-1683407

Okun, M. L. (2016). Disturbed Sleep and Postpartum Depression. Current Psychiatry Reports, 18, 66. DOI 10.1007/s11920-016-0705-2

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