Supporting and Caring for Someone with Perinatal Depression and Anxiety – By Dr Sofia Rallis

The impact of Perinatal Depression and Anxiety

Perinatal Depression and Anxiety (PNDA) refers to depression and anxiety experienced during pregnancy and/or the first year post-birth by expectant and/or new mothers and fathers. As outlined in previous articles, up to 1 in 10 women and up to 1 in 20 men experience depression antenatally, while approximately 1 in 7 women and up to 1 in 10 new dads experience depression following the birth of their baby. Anxiety can also be just as prevalent, if not more so. The experience of clinical depression and anxiety extend far beyond a ‘normal’ period of adjustment and have a significant negative impact on all facets of one’s life. Common symptoms include experiences such persistent  low/flat mood, increased irritability and/or anger, loss of interest in things/activities that are usually enjoyable, feeling constantly tired or exhausted, sleep disturbances (unrelated to baby’s sleep), fear of leaving the house, and withdrawing from one’s partner, baby, family and friends. Individuals can also be reluctant to speak openly about their struggles with PNDA, given that they are at odds with the expectation that this time in one’s life ought to be a ‘joy filled’ time. This can further compound the sense of isolation often experienced and make it harder to reach out for help. Relationships with key people (i.e., partners, family and friends) are impacted, and generally the more time that goes by where a partner does not seek treatment, the more likely it is that the other partner will also experience a decline in their own mental health and wellbeing. From a parenting perspective, it can also be especially difficult to find the emotional energy, patience, desire and capacity to connect with one’s baby, other children and loved ones when feeling anxious and/or depressed. These factors are just some of the reasons why seeking help early is so important.

Impact of perinatal anxiety and depression on carers and partners

Caring for someone who is struggling with PNDA can be both difficult and confronting. You might experience a range of emotions such as:

  • Confused or uncertain about what to say or do to help: “I don’t know what to say in case I make things worse”
  • Useless: “Nothing I say or do seems to help!”
  • Frustrated and angry: “Why is he/she being like this when I am trying so hard to help?”
  • Overwhelmed: “It’s all too much, I don’t know what to do”
  • Alienated: “I don’t understand how or why they are feeling this way
  • Unsure about how or when to help: “Am I interfering? Should I be helping more? Should I back off and let them have some space?”
  • A sense of loss: “When is he/she going to be their ‘old self’ again?”
  • A loss of support: “The person I used to turn to and rely on is no longer there for me.”

In addition to the possible emotions outlined above, it is also easy to feel confused or even frustrated if your partner or loved one seems reluctant to seek help. It is important to understand that this reluctance is probably due to a number of common fears and misconceptions that exist about PNDA.
Some reasons your partner or loved one might be reluctant to seek help may include:

  • They might not know what antenatal or postnatal anxiety or depression is and how it differs from the ‘normal’ struggles associated with being a new parent.
  • They might not be ready to acknowledge and admit that they are struggling to cope.
  • They might be finding it difficult and confusing to put painful feelings and/or scary thoughts into words.
  • The symptoms of depression itself often make it harder to seek help: i.e., low energy, low mood and motivation and a general sense of hopelessness (e.g., “what’s the point anyway?”).
  • Feelings such as guilt and/or shame may be present in regards to how they feeling.
  • They might hold a belief that having PNDA means they cannot be a good parent at the same time.
  • They might believe they should be able to just ‘get over’ how they are feeling and ‘just push through’.
  • They might have previously had a negative experience with a doctor or health provider.
  • They might be frightened that if they seek assistance they will be admitted into hospital, put on medication and/or have their baby taken away.

What can I do to help support my partner/loved one?

When your partner or loved one is struggling with PNDA, it can be difficult to know what to do. Furthermore, each family’s own unique set of circumstances also needs to be taken into account in regards to what constitutes appropriate and ‘useful’ support. Some general suggestions on what you could do to help a loved one include:

  • Focus on providing practical help and gentle emotional support. Try and listen when your loved one expresses difficult or uncomfortable feelings or thoughts without jumping in to ‘fix it’, or ‘make it better.’ Sometimes being present and listening is enough.
  • Ask your loved one what type of help/support might be useful for them and actively listen. Avoid the temptation to take over, or overwhelm them with lots of information or suggestions.
  • Encourage your partner, friend or family member to speak to a suitable health professional such as their GP, obstetrician, midwife, child health nurse or PANDA’s National Perinatal Anxiety and Depression Helpline.
  • Perinatal anxiety and depression can affect every area of wellbeing including decision making, and how one views themselves, others and their future. It is probably not the best time to make significant life decisions about things like your relationship, children, career or house so try to avoid adding any extra pressure about such issues.
  • Seek and/or accept offers of practical help from family or friends where available. It is OK for someone to come over and help do the washing or cooking. Try to let go of any reluctance you may have about this.
  • Try to keep an eye out for any warning signs that your loved one’s mental health is deteriorating. Have a plan in place about what you might do if this were to occur (Note: some suggestions actions steps are noted in the following section)
  • Looking after your own physical, emotional and mental health is essential if you hope to provide ongoing support to your partner/loved one. Exercise, a healthy diet, limiting alcohol consumption and sufficient sleep are all relatively simple steps that can make a difference in your own self-care. It is also important to think about who is supporting you at this difficult time?

What else do I need to be mindful of?  

Some partners, family and friends don’t necessarily understand what is happening to them or their loved one when PNDA is experienced, particularly when the symptoms of depression and anxiety are severe. In some cases, things can enter a scary and dangerous territory.  If you are concerned that you or someone you care about is at risk of suicide or harming themselves/others it is critical that you seek immediate help by contacting your GP, a suitable Crisis Service, or your nearest hospital’s emergency department. You can also contact services such as PANDA for advice and support. If you believe that someone’s life is at immediate risk, then call 000.

Immediate action needs to be taken if you observe any of the following:

  • Suicidal thoughts, details or plans to take own life
  • Self-harming behaviour (e.g., cutting)
  • Excessive use of alcohol or drugs
  • Potential harm to the baby and/or other children – this might be in the form of neglect or difficulty caring for the baby, physical abuse as a result of an inability to cope, and/or emotional harm due to bonding and attachment difficulties.

Actions to take:

While difficult, it can be helpful for partners, family and friends to explore these areas of potential risk by asking some questions in an appropriate manner (i.e., directly, yet gently and in a non-judgmental tone). It is important to contain one’s own emotions and reactions in such situations, in an effort to encourage the individual who is struggling to speak openly and honestly.

Some examples of questions you might consider asking include:

  • Do you ever have thoughts or feelings that scare or worry you?
  • Do you ever have thoughts or feelings that make you worry about your or your baby’s safety?
  • Do these thoughts ever become more detailed such as thinking about a plan?
  • What stops you carrying out your thoughts or plan?

It is important to note that asking these questions will not elicit suicidal ideation or give “someone ideas”. Instead, for many people who are experiencing difficulties, it can be a relief to be asked questions such as these and to be able to speak openly about their thoughts, especially if their responses are received in an open and supportive way. If your partner/loved one responds in a way that concerns you, the following action steps might be necessary:

  • Ensure that someone is with them and their baby until they receive treatment and support
  • Arrange for them to see their GP and/or a trusted health professional as soon as possible so that they can be assessed and have the appropriate supports put in place
  • If the risk is more immediate they might need to be admitted to hospital; an ambulance may need to be called
  • Encourage them to continue to talk about how they have been feeling. Acknowledge how difficult this must be for them and remain supportive.

Summary:

Perinatal depression and anxiety affects both men and women from all walks of life and makes it difficult for individuals to function effectively both at home and at work. Given the impact that perinatal depression and anxiety can have, particularly when left untreated, suitable pathways to support accurate identification and treatment is essential. If someone you care about is struggling, it is important to support your loved while also looking after yourself at the same time. You can help your partner/loved one by encouraging and supporting their treatment as well as by offering emotional and practical support. Enlist and accept help from other family members and friends where available, as well as professional assistance. It is important to remember that PNDA is a condition that is temporary and treatable. As hard as it may be to admit that help is needed, take this first step and reach out for some help. The journey of parenthood is complicated and unpredictable and there is no manual, so we all need some extra support at times. Remember how important it is to look after yourself so that you can keep looking after your family!

Written by Dr Sofia Rallis

References and sources for additional information:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Washington, DC: Author.
  • Austin M-P., Highet N., and the Expert Working Group (2017). Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence.
  • (2011). Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue: The national depression initiative.
  • Beyondblue (2012).Managing mental health conditions during pregnancy and early parenthood: A guide for women and their families
  • PANDA (2013).Perinatal anxiety and depression partners and carers factsheet: https://www.panda.org.au/images/resources/Resources-Factsheets/Caring-for-Someone-with-Perinatal-Anxiety-and-Depression.pdf

Disclaimer:

Please note that the information provided in this article, and any associated references, is general and is not intended to be therapeutic in nature. If you feel that you would benefit from additional information, support and/or require urgent assistance please contact your GP, or one of the following services in your state.

Crisis and Support Services

National Services:
Lifeline
13 11 14 (24 hours a day, 7 days a week)
www.lifeline.org.au

Perinatal Anxiety and Depression Australia (PANDA)
1300 726 306 (Monday-Friday 9am – 7.30pm (AEST / ADST)
www.panda.org.au

Pregnancy, Birth and Baby Helpline
1800 882 436
https://www.pregnancybirthbaby.org.au

MensLine
1300 78 99 78
www.mensline.org.au

Suicide Call Back Service
1300 659 467 (24 hours a day, 7 days a week)
www.suicidecallbackservice.org.au

Additional State Based Services:
Victoria:
Maternal and Child Health Line 24 hours a day, 7 days a week 13 22 29
Parentline VIC 8am to 12am Monday to Friday, 10am to 10pm weekends 13 22 89

NEW SOUTH WALES:
Karitane Careline 24 hours a day, 7 days a week 1300 227 464
Parentline NSW 24 hours a day, 7 days a week 1300 130 052

ACT:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parentline ACT 9am – 9om Monday to Friday (except public holidays) (02) 6287 3833

QUEENSLAND:
Child Health Line 24 hours a day, 7 days a week 13 43 25 84
Parentline QLD & NT 8am to 10pm, seven days a week 1300 30 1300

SOUTH AUSTRALIA:
Child and Youth Health Service 9am – 4.30pm Monday to Friday 1300 733 606
Parent Helpline SA 24 hours a day, seven days a week 1300 364 100

WESTERN AUSTRALIA:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parent Help Centre WA 24 hours a day, 7 days a week 1800 654 432

NORTHERN TERRITORY:
healthdirect Australia 24 hours a day, 7 days a week 1800 022 222
Parentline QLD & NT 8am to 10pm, seven days a week 1300 30 1300

TASMANIA:
Parenting Line TAS 24 hours a day, 7 days a week 1300 808 178

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