This article was co-authored by Nikita Baxi and Robert Muller, PhD.
Postpartum depression is a form of clinical depression that affects 10 to 20 percent of women after childbirth. Recent data from 2010 to 2020 reveal a troubling increase in its prevalence, particularly among marginalized populations. Alarmingly, death by suicide is a leading cause of maternal mortality, accounting for around 20 percent of postpartum deaths.
Postpartum depression is typically marked by a lack of interest in the baby, lack of bonding, anxiety about the child, feelings of being a bad mother, fear of harming oneself or the baby, crying, and feelings of hopelessness and worthlessness. It often negatively impacts a child’s development as well. Anxiety disorders often co-occur with postpartum depression.
Angela Bishop, a registered social worker and certified perinatal mental health provider, notes, “Women experiencing postpartum depression and anxiety often face challenges in seeking support or treatment due to stigma surrounding mental health, feelings of guilt or shame about their struggles, and fear of judgment from others and being seen as inadequate or not good enough.”
They are less likely to report symptoms of depression and seek support at postnatal follow-up appointments due to feelings of guilt and shame. Sometimes their concerns are not taken seriously, or they experience barriers to accessing appropriate treatment.
Getting Ahead of the Problem
Most research has focused on forms of treatment for postpartum depression. For example, for women who received treatment for postpartum depression, cognitive behavioural therapy (CBT) or antidepressants are the most typical approaches.
However, little attention has been given to mental health promotion strategies. Preventive mental health care, which focuses on reducing the likelihood of developing psychiatric disorders and promoting resilience, is increasingly becoming an important next step in mental health services.
Research on preventive approaches for expectant mothers’ mental health is scant. However, a recent study by Pamela Surkan and colleagues at Johns Hopkins University (2024) found that anxiety-focused CBT is an effective method to reduce the likelihood of mothers developing anxiety disorders and postpartum depression.
Pregnant women with mild symptoms of anxiety and without clinical depression were recruited for the study. These participants were chosen because pre-birth anxiety often predicts anxiety, depression, and suicide risk after giving birth. The pregnant women were then divided into two groups: One would receive six sessions of preventive CBT, while the other would receive pre-birth care as usual.
Women who received the preventive CBT had an 81 percent and 74 percent reduction in the odds of depression and moderate-to-severe anxiety, respectively, six weeks after giving birth. Only 12 percent of the women in the group receiving preventive CBT developed postpartum depression, compared to 41 percent in the control group that received regular prenatal care.
Addressing Risk Factors
The results suggest that preventive measures for pregnant women’s mental health are promising and should be implemented in prenatal care services for women presenting risk factors for postpartum depression and anxiety. Bishop states that common risk factors include a history of anxiety or depression, hormonal fluctuations, lack of strong social support, stressful life events like previous traumatic birth experiences, financial strain, or relationship difficulties, and pressures to meet societal expectations.
Recognizing these risk factors allows for targeted support and intervention. Integrating CBT with existing prenatal care supports may greatly reduce the extent of mental health issues that mothers experience before and after giving birth.
Bishop says CBT shows promise as a preventive intervention for reducing the risk of postpartum depression and anxiety. “By addressing negative thought patterns and teaching coping strategies early on, CBT can empower women to manage stressors more effectively and build resilience during pregnancy and the postpartum period. Including CBT in prenatal care can also help normalize discussions about mental health and destigmatize seeking support for emotional well-being.”
Tailoring Interventions to the Individual
However, Bishop also notes that this approach may not be enough for those with complex needs and histories. In such cases, preventive approaches to mental health care may be considered in conjunction with other therapeutic approaches and strategies, such as mindfulness and social support interventions.
Pregnancy and the postpartum period can be an especially vulnerable stage in a woman’s life, where mental health concerns can significantly impact both maternal and infant well-being.
Planning ahead for the postpartum period is incredibly important in bolstering mental and physical health. A proactive approach to maternal mental health care can assist in creating a strong support system and help manage stressors.
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