Severe anxiety in new mothers far more common than depression, new research shows

Erin Ellis
June 6, 2016

VANCOUVER — Severe anxiety is three to four times more common than depression during pregnancy and early motherhood, according to newly published research from the University of British Columbia.

Psychologist Nichole Fairbrother led a team that studied 310 pregnant women in Metro Vancouver from 2007 to 2010. They filled out a questionnaire on their mental health, and that was followed by in-depth interviews with 115 of them.

The team found that 16 per cent of pregnant women and 17 per cent of new mothers could be diagnosed with an anxiety disorder compared with four per cent of pregnant women and five per cent of new mothers with depression.

“The implication of this finding is we have a collection of mental health conditions that we’re not paying enough attention to,” Fairbrother says. “Anxiety disorders cause a huge amount of emotional distress, they compromise quality of life, they’re associated with lots of health-care cost and they’re impairing, so they interfere with the ability to work.”

“We don’t have a lot of data on this yet, but they very likely influence parenting and the quality of the mother-infant relationship. We know that anxious moms communicate less effectively with their infants,” says Fairbrother, an assistant professor in the UBC Island Medical Program in Victoria.

“And if we’re only paying attention to depression, we may be providing inappropriate treatment. Women may be getting treated for the wrong thing.”

Other research has pointed in the same direction, but didn’t involve such a comprehensive personal interview, she says of new work published online this spring and scheduled to be in the August edition of the Journal of Affective Disorders.

I remember looking out the window and feeling alone and trapped, so the thoughts got really, really powerful. I had to call my husband and ask him to come home. I didn’t want to be alone with the kids because I didn’t trust myself
While most new parents worry — and perhaps worry a lot — anxiety disorders go beyond everyday concerns about keeping the baby healthy or saving for a college fund. Instead, women with anxiety disorders are plagued with intrusive thoughts about deliberately harming the baby. They may be compelled to avoid the unavoidable — germs, for instance — leading them to isolate themselves at home or even wash their babies with a dash of bleach.

Previous research by Fairbrother found fears of the baby being harmed accidentally are universal among new mothers and about half of them also experience unwanted thoughts of hurting the child themselves.

Because there is so much shame associated with being a bad mother, women usually speak to no one about their thoughts until they become unbearable. Treatment with cognitive behavioural therapy can help them dramatically, says Fairbrother, but many women cannot afford therapy or even find such treatment if they live outside large cities.

“We should be making sure that women have access to non-pharmacological interventions for these disorders.”

Hollie Hall, a counsellor with the Pacific Post Partum Support Society in Burnaby, calls postpartum anxiety an agonizing condition. She coped in strict silence with intrusive thoughts of harm with her first baby. With a second child three years later, she feared she was losing her mind.

Her daughters are teenagers now, but Hall was at home with them in 2001 when news of the day was filled with terrorist attacks on the World Trade Center in New York and Texas mother Andrea Yates drowning her five children in a bathtub.

“You’re a vulnerable new mom and you’re thinking the world is going to end. … Then I heard about Andrea Yates in Texas and I was convinced that was going to be me,” Hall says.

“I remember looking out the window and feeling alone and trapped, so the thoughts got really, really powerful. I had to call my husband and ask him to come home. I didn’t want to be alone with the kids because I didn’t trust myself.”

She ended up taking medication for anxiety and working with reproductive mental-health specialists at B.C. Women’s Hospital to sort out her destructive thoughts.

“I never thought I’d be where I am today, talking openly about it and helping other women.”

North Vancouver psychologist Michelle Haring says many women with anxiety fear it will somehow develop into postpartum psychosis — the diagnosis for Yates — but that rarely happens and almost always follows an existing mental illness such as schizophrenia or bipolar disorder.

“There’s never a better day in my job than when I get to provide information that says anxiety is extremely common and in 99.9 per cent of cases it’s not part of a postpartum psychosis. It’s not something that people are going to act on and it’s treatable,” Haring says.

Haring, who has more than a decade’s experience treating anxiety and has written self-help manuals, says women are often misdiagnosed with depression because there are overlapping symptoms. And anxiety can contribute to depression because of the constant bombardment with catastrophic thoughts.

When it comes to treatment, the most accessible option — medication from a family doctor — is something many women won’t consider.

“A lot of women are reluctant to take medication while they’re pregnant. Postpartum, they’re concerned about the effect it has on the baby through milk.”

A free online manual Haring wrote for the B.C. Reproductive Mental Health Program on coping with anxiety during and after pregnancy walks readers through the need for self-care — eating and sleeping enough — and then examining their thoughts that don’t reflect reality.

Once in the throes of anxiety, women tend to believe their random thoughts carry significant meaning, which is not true, Haring says. The fact they are deeply upset because harming a child entered their minds means they want to protect that child.

Some self-help techniques sound like advice from a wise friend. Ask yourself, five years from now if I look back on this situation will I look at it differently? Or: am I blaming myself for something over which I do not have complete control?

More in-depth, individualized therapy involves weaning off counterproductive behaviours such as repetitive checking, obsessive Internet searches or avoidance of everyday situations like taking public transit.


Getting help

Metro Vancouver is well-served by psychologists with training in cognitive behavioural therapy, but their services are not covered under public health care unless the patient is in the hospital. Here is a list of helping agencies or free resources:

* Pacific Post Partum Support Society

604-255-7999

Toll-Free 855-255-7999

Request Rejected

* B. C. Reproductive Mental Health

reproductivementalhealth.ca/

* Manual: Coping with Anxiety during pregnancy and following the birth

http://www.cw.bc.ca/library/pdf/bcrm...uide_final.pdf

* Canadian Mental Health Association

Home Page - Canadian Mental Health AssociationCanadian Mental Health Association | Mental Health for All

* Bounce Back, self-help DVD and telephone coaching

Bounce Back: Reclaim Your Health | Canadian Mental Health Association BC Division

1-866-639-0522