The Ripple Effect of Postpartum Depression

My mother, now 54, dealt with depression and anxiety after the births of my younger siblings, but she told me she never even heard the words “postpartum depression” until we were much older. There was a lack of screening and education at the time, which meant she wasn’t being treated. It’s impossible to say if her experience is directly connected to my own struggles with postpartum depression. After all, for me, there were other factors at play: a difficult relationship with my father, grief, and financial strain.

Still, being the child of a parent with depression has long been associated with an increased risk of that child struggling with depression, too. A recent study published in JAMA Psychiatry shed light on the effects postpartum depression might have over the long term.

Researchers collected information from just under a thousand women who gave birth in England from April 1991 to December 1992 and then outlined the specific risk factors associated with postpartum depression. Data from mothers who had depression that persisted at least eight months after giving birth (defined as moderate to severe) was examined.

From this sample, they found that it was common for a postpartum depression diagnosis to persist as chronic depression up until their child’s 11th birthday. The children of these mothers had a 4-fold increased risk for behavioral problems during their preschool years and were more likely to struggle with math in their teens. At the age of 18, the risk of these children dealing with depression was increased by 7-fold.

Now, it's easy to jump to conclusions—to see this data and feel like moms dealing with postpartum depression, and their children, are destined for bad outcomes—but there are important things to note about this study. First, this population dealt with persistent PPD, testing as having moderate to severe depression at both two months and eight months postpartum. Secondly, they weren’t really being treated; it's estimated that only 1 percent of the mothers were taking an antidepressant.

“One of the things the study highlights is that we’re probably missing a lot of maternal depression and we’re seeing the impacts of unrecognized and untreated depression,” says Steven Levine, a Princeton, New Jersey-based psychiatrist (not affiliated with the research) who believes the results of this study reflect the limited education on maternal mental health at the time. He also says that better screening now is the key to preventing these patterns from perpetuating.

“I wish I’d been happier as a mother,” my mother says, when we’re having a conversation about this pattern. She tells me that better support and education could have made motherhood a more enjoyable experience for her. We don’t talk about the potential for a better outcome for my siblings and me. Instead, we connect over a shared experience—her postpartum depression and mine, and the differences in screening and treatment we each received.

Erin Heger, a 28-year-old writer from Kansas City, Missouri, says her mother, in comparison, did receive treatment for her postpartum depression and is very open with her about the experience. Her mom describes her PPD experience as a sort of numbness: “It’s as if there was no color in the world.” She tells Heger of suicidal thoughts and how her postpartum depression morphed into a chronic condition that she’s managed with medication for more than 20 years now.

Heger has no doubts that her mom’s depression impacted her; she feels her mother may have been unavailable or distant during the times when she was struggling the most. Heger also remembers times of her mother’s episodes of anger that she now believes were likely linked to her PPD. It was her mother’s diligence, however, that has stood out above anything else.

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“My mom got help, and because of that she was able to be as present as she could and create a happy childhood for me and my siblings,” she tells me, adding that her mom’s honesty was what helped her to spot her own postpartum depression early on. Our younger brothers are the same age, which means that Heger’s mother was being diagnosed and treated for postpartum depression while my mother wasn’t even being screened.

Jenny Salvoni, a 35-year-old mom living in Dallas, Texas, is another woman whose mother experienced both postpartum depression and additional chronic mental health problems. Describing her mother as angry and isolating, she says she has no memory of her mom seeking treatment for her mental illness. She no longer has a relationship with her mother.

Salvoni has been in treatment for obsessive compulsive disorder and depression off and on since the age of nine. She’s determined to even more proactive, now that she’s a mom. Early on, she noticed similar feelings and behaviors toward her 21-month-old son, that she saw in her mother growing up—the temptation to lash out in anger, utter exhaustion, and resentment. So she decided to implement a regular therapy schedule.

“I did it because I knew I needed reprogramming and needed to learn how to interact with people in a positive way,” Salvoni says. “I never want a child to feel any of the pains I did.”

Lessening the impact of postpartum depression is a complicated issue. The weight often falls on the new mother to seek out screening and treatment, and even with new treatments in the works, access to care is a huge issues for many moms.

Levine says there’s been more awareness in the past few years, but that doctors don’t see a mother as much after delivery.

Moms who have prenatal depression, or experiences with depression before pregnancy, are at higher risk for postpartum mood disorders, making screening during pregnancy valuable. Still, it doesn’t do any good for mothers who don’t experience symptoms until weeks or months after their child is born.

Levine calls for more discussion on how mothers can be more consistently screened for depression in the several months that follow birth, whether that be at well visits for their child or follow-ups with their own care providers. (ACOG recommends that "all women undergo a comprehensive postpartum visit within the first six weeks after birth" but a large percent of women don't go to these appointments.) To alleviate the effects of postpartum depression on both mom and child, Levine says the answer seems simple at first, but is actually fairly complicated. “Just because somebody identified, ‘I need help and I’m willing to get help,’ doesn’t necessarily mean it’s available quickly,” he tells me.

Levine cites limitations and other factors that hold moms back like wait times for therapy, psychiatrists with no availability for new patients, and treatments that aren’t always effective. Still, he urges moms who are struggling with depression to speak up, reach out to their partner or friends, and seek out professional help.

As for me, this study is a reminder of the urgency of continuing to care for my own mental health and the importance of talking honestly with my three children about my postpartum depression and how it might impact them in the future.

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