Postpartum depression (PPD), an episodic period of dejection following childbirth, is most commonly associated with feelings of sadness, anxiety and detachment. According to a new study, there’s another symptom related to PPD we should all be paying attention to, but it’s most often ignored.
Researchers from the University of British Columbia analyzed 25 years’ worth of maternal postnatal depression literature and found that anger was a major feature of some women’s PPD.
However, as the study authors point out, healthcare professionals and researchers have historically overlooked anger as a symptom, and even the most popular screening tools do not address its presence. For example, the Edinburgh Postnatal Depression Scale, a postnatal health questionnaire given to mothers approximately six weeks after giving birth, neglects to examine feelings of hostility. The questions, such as “I have been anxious or worried for no good reason” and “Things have been getting on top of me” focus more on traditional concepts about depression.
Based on the findings, study authors suggest screening for anger in addition to depression and anxiety, since having anger plus depression can make things even more difficult for new moms and their families.
“We know that mothers can be depressed and anxious in the postpartum period, but researchers haven’t really paid attention to anger,” explained study co-author and nursing Ph.D. candidate Christine Ou to UBC News. “There’s some evidence that indicates that being both angry and depressed worsens the intensity and length of depression. That can have many negative effects on the mother, child and family, and on the relationship between parents.”
Ou’s analysis, published in the journal Birth, suggests that this anger is fed by feelings of powerlessness, an incompatibility between reality and expectations of motherhood, and unmet expectations for support.
“Anger can be a reaction to broken expectations about what mothering will be like,” Ou told UBC News. “Mothers may feel that they have not met their own expectations and that also others may judge them because, for example, they’re formula-feeding instead of breastfeeding. Many mothers have also expressed feeling let down by others in terms of support from partners, family members and healthcare providers as well.”
But why have we ignored the emotion that so obviously needs close examining? Ou believes it involves the lack of acceptance across different cultures. Regardless of the past, it is critical for healthcare providers and researchers alike to identify when these negative emotions come into play.
“We know that children who are exposed to parental anger or depression are at a greater risk of developing emotional problems,” said Wendy Hall, Ou’s thesis supervisor and the study’s co-author. “It’s important for healthcare providers to examine maternal anger in the postnatal period in order to understand and manage that risk.”