Depression in new mothers

Postpartum woes

There are more chances of women who have just had a baby committing infanticide or suicide, says Dr Girish Babu N.

Parvathi (name changed), a 27-year-old housewife was brought to the emergency department of the hospital by her family. She had killed her two-month-old baby, tried to kill her five-year-old child and then hang herself. She had not tried to conceal her actions and had confided in her relatives. For those who knew Parvathi as a soft spoken, caring mother this was unbelievable and her family was in a state of shock.

When she was brought to the hospital, she had been terrified  and sad for the past four weeks. She had been imagining that she and her children would be killed.  Her husband reported that she had been depressed following the birth of their first child, as well.

Infanticide is the deliberate act of a parent killing his or her own child within a year of the birth of the child. When the baby is killed within 24 hours of birth, it  is called neonaticide. While neonaticide is more prevalent in young and single mothers, infanticide is common in older and married mothers. Female infanticide is more prevalent in the Indian context due to social causes.

More than 75 per cent of mothers committing infanticide had some mental illness or the other. Depression is the most common cause of infanticide and suicide. In contrast to other homicidal persons, mentally ill mothers make no attempt to conceal their act. They generally confess to the crime and request for punishment.

Suicide is one of the leading causes of death in the 15-44 age group, according to a study conducted by the World Health Organization. Suicide accounts for up to 15 per cent of deaths of women within one year following delivery (the postpartum period).

Confidential enquiries into maternal deaths in the UK, during the postpartum period, revealed that suicide was one of three leading causes. Two thirds of these women who committed suicide had severe depression. The risk is significantly high during the first few months after childbirth.

Although maternal mortality rates are as high as 4 per 1000 live births in India, it is surprising that no epidemiological data exists on maternal suicide. Factors which consistently increase the risk of suicide in postpartum women, are the presence of depression, pre-existing mental illness, young age of the women, use of addictive substances and death of the infant. Depression in women is high during the postpartum and post menopausal period. This may be due to the low levels of the female hormones (oestrogen).

World Mental Health Day is observed every year on October 10, and the theme  this year was, ‘Depression, a global crisis’. It is important for all of us to understand that depression is a common mental illness, which is seen more often in women in their postpartum periods.

Early recognition and treatment can avert both suicidal behaviours and protect the health of the infant. Depression in postpartum women starts within two to four weeks after delivery, initially with reduced sleep and insomnia. This is followed by irritability and a feeling of sadness that lasts for long periods of time, difficulty in caring for the child, lack of interest in playing with her baby and refusal to eat. Other symptoms include angry outbursts and refusal to breastfeed the child. When depression increases it is associated with thoughts of suicide and infanticide. Hence, early recognition and institution of appropriate treatment should be done to prevent devastating consequences.

Early identification of women with postpartum depressive illness can save the lives of many mothers and infants. 

Symptoms are usually seen within days to weeks of delivery.  As most of the women are under the care of obstetricians and pediatricians, it is important to identify these symptoms early on and refer them to a psychiatrist whenever present. As there is almost a 50 per cent chance of recurrence, these women should be monitored for recurrence of symptoms in subsequent pregnancies. Effective treatments are available in the form of medications, electroconvulsive therapy and counseling.

At Karnataka’s SDM College of Medical Sciences and Hospital, the Department of Psychiatry has started a 24-hour helpline for suicide prevention and in helping people with mental illness. Those in need can call 0836 2477890, or call the 24-hour helpline: 09243260299, or email: [e-mail]