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MIND

Why is depression during pregnancy on the rise?

Anxiety and depressive symptoms during pregnancy have risen by 51% in one generation. We must ask why, says Emily Reynolds

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By Emily Reynolds on

Yasmin was seven months pregnant when she started to feel overwhelmed. Twenty years old and expecting her first child, the magnitude of her responsibilities began to set in. “We’d finally bought everything we needed and started renting a new house,” she says. “And it was the first time I’d been able to actually think about the whole situation.”

What began as feelings of anxiety and stress spiralled, and Yasmin began to cry “six or seven times a day”, feeling as if her relationship with her partner wasn’t going to work and that she wasn’t fit to be a mother. “I wanted to pack up and leave, essentially,” she says. “I felt out of my depth.”

Yasmin, now 21, is just one of thousands of young mothers who experience depression and anxiety during pregnancy. And it’s only getting worse: a recent study from the University of Bristol, published in JAMA Open Network, found that anxiety and depressive symptoms during pregnancy have risen by 51% in one generation. In the 1990s, 17% of young mums surveyed by researchers were above the threshold for anxiety and depression; it’s now 25%.

“It was common before, but it’s even more common now,” explains Rebecca Pearson, lead author of the research and lecturer in psychiatric epidemiology at the University of Bristol. “It’s not like it’s a new phenomena – 17% was a lot of young mums back in 1990. But obviously, despite efforts to support women, it’s still rising.”

Annie Belasco, media manager at the PANDAS Foundation, who help families affected by pre- and postnatal illnesses, says that women who have experienced mental-health problems prior to becoming pregnant are “more likely” to experience prenatal depression. “But there are so many varying factors,” she says. “Environment, financial circumstances, relationships, pregnancy sickness... these can all induce illness while pregnant.”

Pearson’s research suggests that symptoms currently appear to be less likely to be depression related, more often linked to feelings of being “overwhelmed, stressed, or panicked” – something that many young mums agree with.

She also suggests two major factors that could be driving the change. The first: working pressures. “A lot more young women are working than in 1990,” she says. “And, even if you love your job, spending all of your time doing it can overwhelming. There’s also a financial pressure – having to work when perhaps you’d rather not.

“There are also new pressures today – young women have expectations and aspirations and ambitions. They’re expected to be mothers and have a career as well, and a lot of people worry about combining the two,” she continues. “They worry maybe that once they're pregnant, people in the workplace might treat them differently, there might be less opportunity.”

Judgement can be a factor for many women. Chloe, like Yasmin, was 20 when she got pregnant; she believes young mums are under pressure because they’re often “looked down on”. Chloe believes her prenatal depression was fuelled by “the stress of being judged”; eventually she ended avoiding uni “at all costs” because she felt frightened that people would judge her. A pre-existing eating disorder also impacted her: “tripling in weight obviously caused stress for me”.

A lot more young women are working than in 1990. And, even if you love your job, spending all of your time doing it can overwhelming. There’s also a financial pressure – having to work, when perhaps you’d rather not

Amy Nickell, author of Confessions Of A Single Mum, relates, with judgement a factor in her experience of prenatal depression. “Being single and pregnant in a world geared toward couples having babies added to the stress,” she says. “Also, the fear that i was 'throwing it all away' by putting my career on hold to have a baby in my twenties definitely added to the way I was feeling.”

And Yasmin was tormented by the idea that young mums “have to have it all”. “We have to still appear youthful and attractive, to maintain a social life but be maternal, to manage work, motherhood, housework, friends, romantic relationships...” she says. “There’s a constant feeling of not being good enough, or not doing quite enough despite stretching yourself so thin.”

It’s not always easy to get support, either. Amy points to PANDAS, but says that “the majority of the time I didn't feel like I could find anyone who understood or could rationalise how I was feeling.”

With mental-health services consistently being cut, though, many women have nowhere to turn. Chloe says she was refused help by the eating-disorder unit because she was pregnant; after she gave birth she began to see the perinatal mental-health team, but was discharged the day after expressing suicidal thoughts “because my baby is almost one”. Yasmin visited her GP and received a referral to a mental-health midwife, who she says was hard to get hold of; she also says she “didn’t feel supported at all” by the NHS services she accessed.

Although specialist services do exist, Pearson says, they have a problem reaching enough women. “It’s a very high proportion, so we do need to get more support for the population level,” she explains. She’s also alarmed by funding cuts for children’s centres – centres that serve the whole community. “They’re more of a stable environment: you can go from pregnancy, to after birth, up to about school age. There needs to be more continuity and community support.”

Belasco also notes that, although the NHS has just announced £23m worth of funding for perinatal mental health, strict guidelines as to who meets the criteria may prove obstructive to many young mums. “At PANDAS, we often pick up the parents who have either not felt like they can really speak about how they’re feeling, or there are just no services available to them.”

Chloe, Yasmin and Amy all agree that community is also key. “I found the best place to find support was from other young mums,” says Amy. “So I think peer support is so important in fighting the loneliness that some new mums can feel. Once you know there are other people in your boat, it can be incredibly comforting.”

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