Study of postpartum depression urged
Medical journal says Canada must investigate new mothers’ suicides
Every death of a new mother through suicide should be thoroughly investigated and reported in Canada to try to prevent postpartum depression from killing women, Canada’s top medical journal says.
“Many women struggle with the stigma of being desperately sad after what is popularly portrayed as the happiest of life events,” says an editorial published Monday in the Canadian Medical Association Journal. “It can be difficult to understand, let alone empathize with, how a mother could become so depressed as to commit suicide or, worse, infanticide,” writes Dr. Kirsten Patrick, deputy editor of the CMAJ.
The death in July of 32-yearold Lisa Gibson of Winnipeg, and her two young children — two-year-old Anna and Nicholas, a three-month-old boy — should serve as a tragic and “stark reminder that postpartum depression can be a killer,” Patrick writes.
Although the official cause of death is unknown, there have been reports in the media that Gibson sought help for postpartum depression following the birth of her son.
Unlike the U.K. and other countries, Canada doesn’t conduct case-by-case inquiries when a new mother dies.
A confidential inquiry into maternal deaths in the U.K. between 2000 and 2002 found mental illness was the leading cause of maternal death. Overall, “more women who had delivered a baby in the previous six months died from suicide than from any other pre-existing medical illness that might complicate pregnancy, including heart disease,” Patrick reports.
New mothers with known risk factors for postpartum depression, including a history of psychiatric illness — especially a previous episode of postnatal depression — a recent stressful life event, domestic violence or not having a supportive partner or family or social supports, should be carefully screened for postpartum depression, Patrick added. “Connecting women with postpartum depression to the right resources can start with simply asking them directly whether they need help,” she said.
No one knows what causes postnatal depression. Most believe it’s a combination of genetic and environmental factors, Patrick said.
It is not the “baby blues,” where hormonal changes can leave new mothers feeling weepy or sad for a few days, and then they “bounce back,” Patrick said.
With postpartum depression comes deep and profound sadness, and feelings of worthlessness. In the most severe cases women become delusional and psychotic, believing they would be better off dead, and that “it would be better off for their babies if they, themselves, were dead,” Patrick said.
The U.K. has a long running audit of maternal deaths, looking at, “what are the cracks that these women slipped through?” Canada’s public health agency, by contrast, tracks maternal mortality, but it doesn’t conduct a formal investigation into the deaths of new mothers on a case-by-case basis. The agency also looks only at women who died in hospital within the first 42 days after giving birth, Patrick said.
Most women who develop postpartum depression develop it long after they leave hospital, she said. They also don’t go to hospital to take their own lives. “They’re not getting picked up by this surveillance,” she said.
“Canada needs something much more intensive,” Patrick said, noting that the U.K. tracks all maternal deaths occurring in the first nine months postpartum.