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Antenatal depression rife, but hidden from doctors

Stigma prevents many women from revealing symptoms to doctors, midwives and family

Louise Prime

Tuesday, 20 October 2015

Up to a third of pregnant women may suffer symptoms of antenatal depression, but guilt and stigma mean that barely half of them discuss the problem with a healthcare professional, according to new research. Leading midwives this morning renewed their call for a specialist perinatal mental health midwife in each maternity service provider, but they also insisted that women’s anxieties and worries about pregnancy should not be overdiagnosed as depression, and unnecessarily medicated.

The latest survey, conducted in the UK among 1000 pregnant women in July and August for BabyCentre, has found that almost a third (30%) said they frequently experience five or more key indicators of antenatal depression – for example, feeling anxious for no reason, losing interest in day-to-day activities and feeling so unhappy that they cry – in contrast with official data, which suggest a prevalence of 10-15% for depression and anxiety during pregnancy. But the stigma around mental illness is preventing almost half of them from seeking appropriate help and support from healthcare professionals.

Of the women affected, 42% said they hadn’t spoken about their symptoms to a healthcare professional. The most common reasons that they gave for this were guilt (reported by 74%), embarrassment about these feelings (62%), or fear they would be judged (58%). Almost half (44%) said that they didn’t seek help because they didn't want to be labelled as mentally ill. More than a quarter (26%) hadn’t even spoken to their partner, a close friend or a family member about their symptoms.

The survey also showed that when women did consult healthcare professionals, they were twice as likely to be prescribed medication as to be referred for talking therapies such as cognitive behavioural therapy (CBT) (15% vs. 7%).

The Royal College of Midwives professional policy adviser Janet Fyle said: “[This] highlights the urgent need for investment in perinatal mental health services. From our own research we know that midwives are often unable to provide the type of support and attention that women suffering from mental health issues require because of a lack of services locally.”

But she went on: “There is also a need to be careful about labelling them as ‘depressed’. This is the area that frightens women into not seeking help. Pregnancy is a life-changing event as women try to negotiate their social roles and imminent role as parents. This upheaval can lead to anxiety and worry. They need support and for someone to understand and explain what is going on with them. We need to consider the appropriateness of prescribing medication because it is important that the prescriber has the expertise on when, and what, to prescribe for pregnant women, and what the potential side-effects of these drugs are.”

In its report last year on postnatal mental health the RCN made several recommendations including care and support for women throughout their pregnancy and beyond, ensuring there is a specialist perinatal mental health midwife in each maternity service provider, and establishing more mother and baby units to care for mothers with mental ill health. Janet Fyle said: “We are still a long way from having the services needed to offer women the level of support and advice that is vitally important to their health and wellbeing.”

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