Depression affects mothers most when child is four years old

Doctors urged to be aware postnatal depression can occur much later than thought, prompting calls for change in care for women.

Four in ten of those suffering depression when their child was older had not previously had any problems Photo: Alamy

Mothers are more likely to suffer depression when their child is four years old than when they are babies, according to a study that has led to calls for a change in the way women are cared for.

Four in ten of those suffering depression when their child was older had not previously had any problems, the study found.

Researchers have now urged doctors to be aware that postnatal depression can first occur much later than thought.

Women who only had one baby were twice as likely to suffer postnatal depression when their child was four years old, than those who had subsequent children, it was found.

The study, which was conducted by Australian researchers, found more than 14 per cent of women suffered depression when their child was four years old.

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Fewer than one in ten at 12 months and eight per cent of women three months after giving birth.

Almost one in three first-time mothers reported suffering depressive symptoms at least once between pregnancy and four years after birth, the study found.

Postnatal depression is thought to affect up to 15 per cent of women in the UK in the first year after having a child and experts said this may now need to be revised.

Dr Hannah Woolhouse, psychologist and senior research officer, from the Murdoch Children's Research Institute, in Victoria, Australia and co-author of the report, said: "It is likely that current systems of maternal mental health surveillance in Australia and the UK will miss more than half the women experiencing depression in the early years of parenting.

"In particular, women who do not have subsequent children may be especially vulnerable to falling through the gaps as they will not be reconnected back into primary care services.

"There also needs to be a focus on social health and relationships as we have found a strong link between depressive symptoms and intimate partner violence."

Dr Carmine Pariante, of the Institute of Psychiatry at King's College London, said nurses and doctors should ask mothers how they are coping whenever they bring their child in for routine vaccinations and other appointments and be aware that depression can hit women at any point.

He said: "Mothers should be encouraged to seek help if they need help.

"This paper is not saying depression in the first few months after the baby is born is not important, it is. But it is also the case that women are vulnerable to depression as their children get older.

"That is due to the stressors to having a child and raising a child. The sooner we can help those women and put them on the right trajectory the better."

The study, published in BJOG: An International Journal of Obstetrics and Gynaecology, used data from 1,507 first time mothers registered to give birth at six hospitals in Melbourne, Australia, who completed questionnaires at three, six, 12, 18 months and four years after giving birth.

The strongest predictor of depressive symptoms at four years post birth were having previously reported depressive symptoms either in early pregnancy or in the first 12 months after childbirth.

Other factors associated with depressive symptoms were being young – 18 to 24 years old – stressful life events in the year before the four year follow-up, violence from a partner or a low income.

The authors of the report said the findings presented a "compelling" case for a rethink on approaches to monitoring maternal mental health where policies focus on pregnancy and the early months after birth.

Dr Woolhouse wrote in the paper: "The fact that one in three first-time mothers reported depressive symptoms on at least one occasion from early pregnancy to four years postpartum, coupled with the finding that the prevalence of depressive symptoms was highest at four years postpartum, provide a compelling case for rethinking current policy frameworks for maternal mental health surveillance.

John Thorp, BJOG editor in chief, said: "Much research has been conducted around maternal mental health during the perinatal period, however, we know very little about the prevalence of maternal depression after the first 12 months of giving birth.

"The findings of this study reinforce the need for an increased focus on maternal health, particularly in the long term, as current guidance for professionals focuses on pregnancy and the early months after birth, and the need to take into account factors linked to the mother's life."

Prof Ian Jones, Professor of Psychiatry at Cardiff University, said: "Clearly services must be aware that mothers remain at risk of depression and that risk does not go away after the postpartum period.

"For more severe episodes of mood disorder - severe postpartum depression and postpartum psychosis - there is no doubt at all that the period after having a baby is associated with very high risk. For example, women are 23 times more likely to be admitted to psychiatric hospital in the weeks following having a baby than at any other time in their life. This study does not change these facts. The more severe episode of depression or mood disorder the more clear it is that childbirth is an important trigger.

"The importance of postpartum depression is not due merely to it being more or less common than depression at any other time.

"Depression at this time has enormous implications for women, their babies and their wider families. Women are in contact with many health professionals through this period and its vital that depression is picked up and treated to prevent the negative outcomes we know are associated with depression at this time."