Social support during experiences of antenatal and postnatal depression

Mothers, as well as a few fathers, talked about social support during experiences of antenatal or postnatal depression. In particular they talked about disclosing perinatal depression to others, the kinds of support they obtained from members of their social network, and the impact of perinatal depression on relationships.

Parents' approaches to telling others that they were experiencing or had experienced antenatal or postnatal depression were shaped by attitudes towards perceived stigma of mental health issues, and their relationship with the person they were telling. Some parents were concerned about stigma and for this reason were careful who they told and for what reason.

Other parents took the opposite approach and consciously decided to be open about their experiences in an effort to help de-stigmatise perinatal depression, or felt being open allowed them to be able to explain aspects of their behaviour. As Melissa, who experienced postnatal depression after her second child, said: 'To me, telling people was not excusing my behaviour, but made them understand.' Fred said he was comfortable being open with his wife, male friends and workplace about his depression before and after his second child's birth as a result of learning about postnatal depression among men in a 'men-only' antenatal group he had participated in.

Zara said she was more willing to be open about her second 'bout' of postnatal depression than her first because her second experience had not been characterised by 'intrusive thoughts'.

Anna described her reasons for speaking up about her experiences of perinatal depression, and said she had encountered very few negative responses.

A few parents described modifying what they told to whom, and why. Factors they considered included how close the relationship was, whether or not they felt the other person was able to understand, or whether they thought they would be distressed by the disclosure.

Chelsea described how she was open about her experience of postnatal depression, but to varying degrees with different people.

Elizabeth described the different people she had disclosed her experience of postnatal depression to, and her reasons for doing so.

Melanie captured a view held by a few mothers when she said: 'I think we talk about the stigma of depression but I think it's actually the depressed people that create the stigma'. Deb found that once she disclosed her experience of postnatal depression, other people shared theirs which prompted her to suggest that: 'I think the more people talk about it, the less isolated you feel, even though I think often the isolation is self-imposed'.

Not all mothers who disclosed perinatal depression experienced positive responses. Some found people struggled to understand, particularly if they had not had children or experienced a mental health issue. Others felt people were uncomfortable upon being told about antenatal or postnatal depression. Maree explained the difficulty she had trying to tell her mother about experiencing antenatal depression: 'my mum and I don't have that kind of relationship and it was kind of like it fell on - not deaf ears but she kind of quickly changed the subject. She didn't really want to go into depth about it'.

Parents experiencing antenatal or postnatal depression mentioned a range of different sources of social support. Key among these were partners, mothers and friends, but mothers' groups, postnatal depression support groups, and online forums were also mentioned by several women. A number of parents said that their partners had been a critically important source of support. Michelle, a mother of one, described the role her husband played during 'episodes' of depression she had experienced, including postnatal depression: 'He sort of understands and then he tries to talk me down. He rationalises things for me I think. If my head's in a mess he'll sort of iron out the crinkles and just help me to see it in a rational light'.

Elly described her husband's support during early parenthood when breastfeeding problems, a slow recovery from foot surgery, and living in a new and unfamiliar area combined to make her 'sad' and 'anxious'.

For a few women, their own mothers or parents were also important social support. Zara's parents supported her including when she stayed with them several times during her first and second experiences of postnatal depression. Anna said after coming home from a mother and baby unit: 'I just had amazing support from my family, between my mum and my husband, during the day I didn't have a minute alone'. Chandrika, a migrant mother who experienced postnatal depression after her first child, described feeling optimistic and 'safe' about the impending arrival of her second baby because her mother had come from Sri Lanka to help her.

Georgia described how her mother and husband 'picked up' that she was struggling after her first baby and were there to support her, even though she did not talk to anyone about her feelings.

A few parents found support in fellow parents or friends who had similar experiences. Chelsea made a close friend with another mother she met in hospital for postnatal depression and commented that they could 'say anything to each other', while Maree found a 'little village of women' on-line who lived in a nearby city and who she would occasionally visit or receive 'packages' from. Tony, a father of two, found long-term friendships helpful: 'Friends that I've had I've had all my life, I find it easier to talk to them. Because they're not going to judge me. And they've had issues with depression and anxiety and things like that as well so it was good to talk to them about it'.

Michelle found attending a mothers' group for women who had experienced postnatal depression 'fantastic'.

Experiencing antenatal or postnatal depression affected parents' relationships with partners, children, family members or friends in different ways. Often the impacts were challenging, especially before people realised they were experiencing perinatal depression, before they sought help or in the early stages of receiving assistance (see Identifying antenatal and postnatal depression and finding help). Many described experiencing increased tension with their partners, frustration with children, distancing themselves from friends, or withdrawing from everyone including their partner or children.

Fred described the impact of the depression he experienced after his second child's birth on the dynamics within his household - his partner, their pre-school aged daughter, and their baby son.

A few women described their partners becoming depressed or needing support themselves. Anna described how after she began to get better after two 'intense' experiences of postnatal depression, her husband: 'certainly went through his own period of grieving, of anger, of all those emotions that he couldn't allow himself to go through while I was unwell because he had to be the rock'.

Maree talked about the impact of her experience of antenatal depression on her relationship with her partner, and his relief when she was diagnosed.

Some parents experiencing depression in the postnatal period found it important to keep in touch with friends, while others withdrew, began turning down social invitations, and became 'isolated'.

Cecilia talked about how it became hard for her to be around her friends after her daughter was born and during her depression following her relationship breakdown.

Several parents commented that the experience of perinatal depression strengthened their relationships. Some parents made new, 'richer' friendships as a result of perinatal depression, while others described growing closer to their partners or children.

Although in the early stages of experiencing postnatal depression Deb thought the problem was her relationship with her husband, she said ultimately going through that experience made their marriage 'stronger'.