Reality of maternal mental health for first time moms in Ireland

A newly published study from Trinity's School of Nursing and Midwifery has followed the prevalence of, and changes over time in, depression, anxiety and stress symptoms experienced by first-time mothers—from pregnancy throughout the first postpartum year. International perinatal literature focuses on depression in the postpartum period. Prevalence and pathways of depression, anxiety and stress from pregnancy through the first postpartum year are seldom investigated.

The study has been published in the journal Archives of Women's Mental Health and coincides with Maternal Mental Health Week which takes place this week.

The MAMMI study (Maternal health And Maternal Morbidity in Ireland) a multi-strand, longitudinal study which has collected information on the health and health problems of >3,000 first-time mothers giving birth in Ireland. The published study incorporates findings from the mental health strand of the study.

No national database exists to collect information about women's mental health in pregnancy and postpartum in Ireland. A handful of studies conducted in specific hospitals/units, or by individual researchers, may only look for example at only depression during pregnancy, or depression and anxiety up until six weeks postpartum.

Although these individual studies are useful, it can be challenging to understand what is really happening with women, the changes in their mental health over time, and the longer-term development or resolution of perinatal mental health problems. A difficulty also arises for researchers and clinicians to properly assess the treatment and service needs specific to the population in Ireland. The mental health data from MAMMI study is invaluable as it covers pregnancy and the entire first postpartum year and reports information about stress and anxiety as well as depression.

Key findings

• 5% of women (one in ten women) reported symptoms of moderate to severe anxiety symptoms (First year postpartum).
• 2% (one in seven women) reported moderate to severe depression symptoms (First year postpartum).
• 2% (one in five women) reported moderate to severe stress symptoms in the first year after having their first baby.
• Depression and stress symptoms measured the lowest during pregnancy but increased after birth at 3 months and were at the highest at 6 months postpartum. Depression and stress dropped a little at 9 months postpartum and then increased again at one year postpartum.
• Women more likely to report symptoms of depression, anxiety and stress postpartum were younger, born in a non-EU country, did not live with a partner, did not have a postgraduate education and were unemployed during their pregnancy.
• The research also found that women who reported experiencing occasional or frequent symptoms of anxiety or depression in the year before their pregnancy were more likely to experience depressive, anxiety or stress symptoms in the first year postpartum, regardless of their age, education and relationship status.
• 1% of women who reported having symptoms of depression in the postpartum year did not have any symptoms of depression during pregnancy.
• 71% of women who experienced symptoms of anxiety in the postpartum year, did not report anxiety during pregnancy.

Researchers believe that despite more conversations around mental health taking place—which in turn help to break the stigma and silence that surround mental health problems—it is important to keep in mind that there are additional aspects of stigma for a mother who is experiencing a mental health problem. Women worry about how they will be perceived by their family and communities for experiencing a mental health problem during a time which society largely regards as a time of happiness and joy. Some women may even think that their ability as a mother will be questioned. This creates an additional barrier to mothers reaching out for support for their mental health.

Speaking on the implications for clinical care, Susan Hannon, Ph.D. candidate and mental health researcher at the School of Nursing and Midwifery and senior author, Trinity said: "At the moment, maternal healthcare stops at 6-weeks postpartum. But our research shows that a substantial number of women are experiencing clinical-level symptoms of depression, anxiety and stress well beyond this period of service provision. This means that women are not supported by a maternity care system that can detect and offer timely treatment to women who need it. Women who experience mental health problems in motherhood have to seek out treatment for themselves, and that can be a very difficult call for a woman to make. Women would really benefit from postpartum healthcare that can support them for longer.

"We hope that this research lets women know that they are not alone, that they too can have these conversations about mental health and motherhood, with family and friends, to lift the silence and share their experience. Talking with healthcare professionals will help women get the support that they need."

Déirdre Daly, associate professor in midwifery, School of Nursing and Midwifery, and co-author, said, "Every time we see findings like this, we have to think about all of the women who shared their information with us—many of these women are suffering—unnecessarily and often in silence."