Tamryn Coats discusses the impact of postnatal depression, and explains why South Africa is particularly vulnerable to this disorder.

1. Pregnancy glow-
postnatal shadows.
Exploring the impact of postnatal depression
Tamryn Coats
2016

3. Postnatal Depression
Baby blues vs PND
Feelings of sadness, tearfulness or just feeling ‘down’, irritability and
mood swings shortly after birth affects up to 80% of new moms.
These are termed the’ baby blues’.
However, when these feelings persist for longer than 3 to 4 weeks, a
diagnosis of post-natal depression can be considered. Diagnosable up
to the first year postpartum.
Just moms?
• International statistics suggest PND affects approximately 5% - 10% of
fathers.
• The most significant determinant of paternal postnatal depression is having a
depressed partner.
• Fathers whose partners are depressed are 2.5 times more at risk for
developing depression themselves

5. Symptom Criteria
• Feelings of worthlessness / guilt
• Lack of concentration
• Perpetuating feelings of sadness
• Loss of interest or pleasure in doing things
• Social withdrawal (often related to guilt)
• Feelings of anger and irritability/ Tearfulness
• Emotional numbing / loss of affect
• Changes in eating and sleeping patterns
• Suicidal ideation/ attempts ““I overdosed some pills;
sometimes I would drink jik” (Case 1).”

6. Postpartum psychosis: restlessness, irritability, reduced
sleep, mood swings, disorientation, confusion,
disorganised behaviour, delusional beliefs often
about the infant, and auditory hallucinations that
commands to harm herself or the baby.
• 1-2 in every 1000 first time mothers
• Occurs generally 2-3 days pp
• Risk: prior mood episodes, history of psychosis,
Bipolar
30-50% chance of reoccurrence with each
subsequent delivery

7. How is it measured?
• Edinburgh postnatal depression scale: quick tool, commonly
utilized, perinatal indication of risk postpartum (score of 13 or
more)
• Responses related to the past 7 days eg. I have been able to
laugh and see the funny side in things. Diagnosable for 1 year
post partum
• In conjunction with clinical interview/ assessment
Moms with untreated PND are 38% risk of chronic depression

8. What does this look like in
‘real life’?

9. I felt so
alone
Everyone said this would
be the happiest time of
my life. But It wasn’t at all
I felt guilty and had
no one to talk to. No
one speaks about it.
I felt like I
was a failure
at being a
woman
I wondered
what was
wrong with
me
It would start crying
and I would just
watch it cry…
I felt so powerless
Lived
experiences
It just didn’t
feel like it
was my baby
I just wanted someone
to take the baby away
from me

10. What does this look like in ‘real life’?
• Mom is unable to bond authentically with her baby
• Baby is referred to as ‘it’ or ‘baby’
• When a baby is crying or in distress mom becomes very
overwhelmed or completely unresponsive
• Mom is unable to pick up her baby / avoids physical contact
with her baby.
• 2 responses: over stimulating or avoidant: Interactions tend to
be more negative (poking, rough) than positive. Mom unable to
read babies cues
• Mom is less likely to talk to and engage affectionately with her
baby (less smiling)

11. • Mom responds differently to others (anger, tearfulness etc)
• Mom may be aggressive / abusive towards her baby. Harsher
forms of punishment
“Yes. I do beat them up. When I am angry I would also start to
shout at them. Like I would yell and force them to sleep. When
they don’t sleep and start to cry I will slap them.” (Case 4).
• Mom may have thoughts of harming her baby (41% of
depressed moms vs. 7% control mothers)
• Mom is neglectful towards her baby – care practices, safety,
routines” “Sometimes when I have to make her take a bath or
wash her nappies I would feel too lazy to do anything and I
would leave everything as it is”. (Case 5).”

12. Still face experiment
Dr. Edward Tronick

13. Impact on the baby
Baby learns that the world is unresponsive, unreliable and scary.
Attachment disorders begin to develop; developmental milestones
delayed.
Mom is not able to
mediate the world for
the baby, contain the
baby’s distress or
interpret emotions
for the baby
Baby feels
confused,
scared,
vulnerable
Overwhelmed by
stimuli or
emotion

14. Infant Outcomes
• Low birth weight
• Delayed initiation of
breastfeeding
• Stunting (milestones)
• Malnutrition
• Gastro-intestinal
problems
• Non-completion of
immunisations
• Increased ICU
admissions
• Crying and irritability
• Fearfulness
• Higher mortality
• Reduced emotional
expression
Child Outcomes
• Impaired motor skills
• Impaired language development
• Weaker adaptation to stress
• Recognition and memory
processes affected
• Lower frustration threshold
• Hyperactivity and attention deficit
• Inconsolability / anxiety
symptoms
• Malnourishment
• Development of asthma in later
childhood
• Internalizing behaviour e.g.
emotional withdrawal
• Externalising behaviour e.g.
aggression / oppositional
behaviours
Adolescence
Outcomes
•Anxiety disorders
and depression
•Shyness
•Unsocial
behaviour
•Conduct disorder
•Attention deficit
disorder
•Substance abuse
•Suicidality
•Increased risk of
HIV infection,
abuse and
unintended
pregnancy

15. Contextual risk factors
• Social stressors: Truama, Low social support systems (unsupprotive
families), Domestic/ partner violence
• Socio-economic stressors (unemployment, poverty, living off a
grant)
• Unplanned or unwanted pregnancy
• Pregnancy during adolescence
• Single parenting
• Stressful lifestyles (including career intensive women)
• Unrealistic expectations of parenthood
• Traumatic birthing process
• Previous episodes of depression, or a history of anxiety disorders
or substance abuse *not restricted to the first child
- Depression during pregnancy (60-70% relapse rate postpartum)

16. Bringing it closer to home
• International statistics suggest that approximately 13% of moms will suffer
from PND.
• Research from the Perinatal Mental Health Project in the Western Cape
suggests PND can reach levels of between 30 and 50% in specific
populations within South Africa.
• Consider the South African context: low income country, high
violence rates, HIV status, high domestic partner violence,
unemployment, patriarchy
50 000 new cases of PND per year in South Africa

17. Treatment

18. References
The knock on effects of postnatal depression. Joanne Zagnoev
Perceptions of postanatal depression and health care needs in a South African sample:
the “mental” in maternal health care. Kathree, T; Selohilwe, O; Bhana, A; Petersen,I.
2014. BMC Womens Health vol.14:140.
Maternal mental illness and child outcomes. Perinatal mentl health project. . UCT
Dr. Janine Pingo. Perinatal depression Presentation. 14 April 2016. Akeso Kenilworth
Clinic.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders: DSM-5. Washington, D.C: American Psychiatric Association.
NHCM Foundation Issue brief, June 2010
Evaluating the clinical effectiveness of a specialized perinatal psychoatry inpatient unit.
Meltzer-Brody, S et all. 2013. Springer
The cost of perinatal depression in Australia. Final Report. October 2012. Deloitte &
PANDA
The prevalence and clinical presentation of antenatal presentation of antenatal
depression in rural South Africa. Rochat, J; Tomlinson, M; Barnighausen, T; Newell, M
& Stein, A. 2011. Journal of affective disorders.