Urban Moms at Greater Risk for Postpartum Depression

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Researchers are narrowing in on the host of factors that can contribute to postpartum depression, from genes to social connections. The latest work focuses on where a new mother lives.

The new study, published in the journal Canadian Medical Association Journal (CMAJ), looked at whether urban or rural locales played a role in postpartum depression rates.

More than 6,400 women who lived in a variety of different geographical areas, including urban, rural, semi-urban and semi-rural areas, participated in the 2006 Canadian Maternity Experiences Survey. (Rural living was defined as settlements with fewer than 1,000 people but more than 400 people per square kilometer. Semirural settings included up to 30,000 people, while semi-urban was defined as including 30,000 to 499,999 residents and urban areas included 500,000 people or more.) They also accounted for whether a woman commuted for work to urban places.

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Overall, 7.5% of the women who had recently given birth in the weeks prior to the survey developed postpartum depression, but women from urban areas were at a greater risk, with a 10% rate, compared to 6% of women in rural areas, nearly 7% in semi-rural areas and 5% in semi-urban areas who developed the condition. The discrepancy is likely due to the disproportionate distribution of known risk factors such as social support and a prior history of depression that have been previously associated with postpartum depression. In the current study, for example, many of the city-dwelling mothers who developed postpartum were members of immigrant populations, which typically have weaker social support networks.

That could explain the counterintuitive result that a woman living among thousands of people in an urban setting, where post natal care and support may be more accessible than in less populated rural areas, can still experience social isolation that can contribute to feelings of helplessness and despondence. Paula Caplan, a clinical and research psychologist at Harvard University and author of “Don’t Blame Mother: Mending the Mother-Daughter Relationship,” who was not affiliated with the study, says that women living in urban environments are also likely to be working multiple jobs, and to be living in poverty. These stressors, on top of raising children, can test the limits of a new mother’s coping skills.

“People say poor mothers suffer from depression. Why is this a surprise? If you’re trying to be a good mother, it is very hard if you are poor and if you are isolated without having a sense of helplessness,” says Caplan.

(MORE: Pediatricians Should Start Screening for Postpartum Depression)

Changes in the family dynamic also play a role; women are more likely to live further away from home than they have in the past, which means they are forced to manage without help from family members. While social networks may be more extensive thanks to social media, those connections still can’t replace the support and reassurance provided by the physical presence of a friend or loved one — especially for a new mother. “There are mommy blogs and social media, but there is no substitute for having someone right there who can break down our isolation and tell you you’re doing fine and your kids are okay,” says Caplan.

While hormones as well as possible genetic markers have also been connected to postpartum depression, Caplan believes that classifying the condition as a mental or physiological problem could take the focus away from social changes that could be made to support mothers. As the study results suggest, isolation and lack of social support can intensify feelings of discouragement, being overwhelmed, and loneliness that any new mother naturally experiences.

(MORE: Study: Fish Oil May Prevent Symptoms of Postpartum Depression)

“We have completely unreasonable expectations for mothers,” says Caplan. “We live in a mother-blaming society where mothers get blamed for almost anything that goes wrong with their child. Mothers can feel isolated or scared to death. There are social changes that need to be made. These women do not need to be treated for alleged mental illness.” The study authors say better daycare options and more supportive services for women who have recently given birth could alleviate some of the burden that mothers feel. And as the results show, these services are needed not just in sparsely populated areas but in densely packed urban ones as well, since it’s possible to feel lonely even when you’re surrounded by people.

1 comments
paulacaplan
paulacaplan

Kudos to Alexandra for writing this important article! Just to clarify a couple of things: One is that I personally have not observed that immigrants are less likely than others to have strong social support systems. In fact, sometimes it is just the opposite, but it depends on a number of factors, including of course the circumstances under which they immigrated and what kind of environment they are living in, as well as whether there is time in their lives to maintain close connections or whether they are too busy just trying to survive. The other is to make clear that I am not saying that no new mother ever has problems that a good, responsible, caring mental health professional could not help with. I am saying that our society has become so psychiatrized that our knee-jerk reaction to sadness, loneliness, hopelessness, physical and mental exhaustion, and despair in new mothers -- all of which are totally understandable due to many new mothers' circumstances and the utterly daunting prospect of (1)having and raising a child and (2)doing that in an intensely mother-blaming culture -- has come to be to diagnose them with psychiatric disorders rather than providing care, support, and a listening ear, as well as confirming for them that it IS totally understandable to have these feelings and that many mothers have them. So psychiatric diagnosis and medical treatment should not be the first thing we jump to do.