Enhancing Parents' Mental Wellbeing during the Postnatal Period

Whether one is a first-time parent or not, the immediate postnatal period is often challenging. The local prevalence rate of postnatal depression is around 10% for mothers and 5% for fathers.1,2A meta-analysis also showed that paternal postnatal depression was positively and moderately associated with maternal depression.3 Without appropriate intervention, parental postnatal depression can adversely impact the parents themselves, the healthy development of their infants, and the family relationship.4,5Therefore, on top of enhancing parenting competency, addressing the psychological needs of parents is equally important to facilitate the health and growth of the newborns. This issue aims to offer tips to professionals in supporting parents presenting with postnatal mood problems.

Psychological Features of Parents with Mood Problems

It is not uncommon for healthcare professionals to come across parents with mood issues; yet, working with parents with postnatal mood issues may pose additional challenges, which can probably be addressed with a better understanding of their clinical presentations.

i) Repetitive Thinking Pattern

Ruminations and worries are very common in individuals with depression and anxiety.6,7Parents with depressive mood may repetitively and passively focus on negative thoughts and experiences, such as the discrepancy between expectations and realities of parenthood, inadequacies as a parent, worries of inappropriate baby care, unresolved interpersonal conflicts etc.4,8

ii) Cognitive Biases and Difficulties

Research also shows that individuals with depressive mood tend to show cognitive biases towards the negatives, such as having difficulties shifting attention away from negative scenes, tendency to appraise things negatively, and enhanced recall of negative events, etc.9。

In addition, parents with mood issues are found to show reduced nurturing parent-infant interactions and increased intrusiveness4,10, which may be a result of the aforementioned cognitive biases interfering with effective problem solving and sensitivity to the cues and needs of infants.

Due to their decreased ability to avoid unwanted thoughts and emotions, parents with mood issues may appear non-attentive or even resistant to health advices. Coupled with their ambivalence towards decision-making (e.g. on mode of feeding) and help-seeking (e.g. for their mood problems), they may appear less receptive to the advices of healthcare professionals. To effectively support parents with these struggles and possible mental characteristics, paying particular attention to the way we make conversations is essential.

What Professionals Can Do

i) Communicate with Empathy

By understanding and accepting the tendency for these parents to ruminate and cope with their problems ineffectively, we could be better prepared to listen to their difficulties and needs non-judgmentally.  For example, exhausted mothers may appear to be irritable and constantly blaming their partners, inadvertently expressing their wish to be cared for in a confrontational way.  Instead of directly challenging their beliefs or behaviours, try to reflect and validate their emotions and solicit more details of their concerns empathically, e.g., "You are disappointed with your partner while his help and care means a lot to you.  In which area do you want him to support you more?  Can you share a bit more with me?"

Then, we can affirm the parents' efforts and normalise their struggles by saying "You've done your best to take care of the baby, at the same time you don't feel adequately supported. It's natural to get frustrated when you feel tired and overwhelmed."

ii) Empower and Focus on the Positives

As parents with mood problems likely bias towards the negatives and tend to overlook the positives, listen carefully to their narratives and look for positive experiences that we can gently reflect and affirm.  For example, "You are very worried that the other family members are not taking good care of the baby when you are at work; but you notice that she seems healthy and happy."  Besides, by listening actively and reflecting accurately on what the parents value, the conversation may shift to positive aspects of the issue as perceived by the parents themselves.  As we build on this conversation and work out the concrete actions that are in line with their values to achieve their goals, we can foster their confidence and instill a sense of hope, e.g. "Doing your best to facilitate your baby's healthy development is important to you, and this is why you could stand with what you are going through.  At the same time, you notice that you can better take care of your baby when you are in a better mood, so you have considered seeking professional help to deal with your mood issues."

iii) Expand Perspectives

In view of their cognitive inflexibility, our goal in working with these parents is to facilitate them to expand their perspectives.  For example, instead of arguing with a mother about the extent her partner cares for her or involves in childcare, acknowledge this as a common challenge among most parents, and broaden her perspective by asking, "apart from unwillingness to involve more, if we try to take the father's perspective, are there any other difficulties that may hold him back from helping more?"

As discussed earlier, parents with depressive mood may be preoccupied with their concerns (e.g. infant health), and tend to miss or misinterpret babies' cues.  Apart from addressing their concerns, facilitate the parents to understand the significance of responsive parenting in nurturing healthy development of the baby.  Upon their permission, coach and encourage them to respond contingently and more frequently with their baby.  This would facilitate parent-infant bonding which, in turn, enhance the well-being of both the parents and the infants.  For example, "Responding to the baby's needs is not easy for new parents, would it be helpful if I share a bit more about this with you?"

iv) Support Autonomy in Decision-Making

If the parent expresses concern on resolving a pressing issue, we may facilitate him/her to make an informed choice.  Be aware that some ambivalent parents may appear to be relying on us to make the decisions for them.  However, when we try to give them any advices, they may very often express hesitations or even opt for the opposite.  Reflecting their ambivalence instead of giving advices, or asking for permission before giving advices, will help empower parents and respect their autonomy.  In the decision-making process, offering information and emotional support in the context of a partnership is therapeutic.

Coping with Challenges of Working with Parents with Mood Problems

Working with depressed or anxious parents who seem preoccupied with their problems could be emotionally draining. Be aware of, understand and accept our responses is most important.  Avoid attributing it negatively to the clients' motivation to change or our abilities to influence them.  Seek peer support and employ healthy self-care practices can help.

Despite the aforementioned challenges, any support professionals may render to the parents could be invaluable to help them cope with interpersonal, parenting and mental health issues.  While parents often feel incompetent in child care and balancing their different roles, professionals could help them recognise that no parent is perfect, and no baby needs a perfect parent; trying their best to meet their children's needs and to take care of their own well-being is already "good enough" to support their children's healthy development.

Being Aware of Postnatal Mood Problems

When postnatal depression is suspected, we should encourage parents and significant others to seek help from the Maternal and Child Health Centre, family doctor, clinical psychologist or psychiatrist. For more information on postnatal mood problems, please refer to the leaflet "Antenatal and Postnatal Mental Health".

References

  1. Hong Kong SAR: Family Health Service, Department of Health (Dec 2019). Antenatal and Postnatal Mental Health. Retrieved on 1 Feb 2021 from http://s.fhs.gov.hk/hv014
  2. Koh, Y. W., Chui, C. Y., Tang, C. S. K., & Lee, A. M. (2014). The prevalence and risk factors of paternal depression from the antenatal to the postpartum period and the relationships between antenatal and postpartum depression among fathers in Hong Kong. Depression research and treatment, 2014, 1-11.
  3. Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. Journal of the American Medical Association, 303(19), 1961-1969.
  4. Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M., Howard, L. M. & Pariante, C. M. (2014). Effects of perinatal mental disorders on the fetus and child. The Lancet, 384(9956), 1800-1819.
  5. Ramchandani, P., Stein, A., Evans, J., O'Connor, T. G., & ALSPAC Study Team. (2005). Paternal depression in the postnatal period and child development: a prospective population study. The Lancet, 365(9478), 2201-2205.
  6. Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on psychological science, 3(5), 400-424.
  7. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review, 30(2), 217-237.
  8. DeJong, H., Fox, E., & Stein, A. (2016). Rumination and postnatal depression: A systematic review and a cognitive model. Behaviour research and therapy, 82, 38-49.
  9. Joormann, J., & Vanderlind, W. M. (2014). Emotion regulation in depression: The role of biased cognition and reduced cognitive control. Clinical Psychological Science, 2(4), 402-421.
  10. Wilson, S., & Durbin, C. E. (2010). Effects of paternal depression on fathers' parenting behaviors: A meta-analytic review. Clinical psychology review, 30(2), 167-180.