Postpartum Depression: A Guide for African Women

 

By: Favour Okere. Freelance Health Writer and Datelinehealth Africa (DLHA) volunteer. Medical review and editorial support provided by the DLHA Team.

Young African woman holding and smiling at her baby. Image from Freepik.

 

 

Key Facts

 

• Unlike "baby blues," postpartum depression (PPD) is a serious mood disorder marked by persistent feelings of sadness, emptiness, or hopelessness lasting more than two weeks after childbirth.

• PPD affects 18.4% of African women and can be accompanied by psychotic symptoms.

• Limited information exists on the treatment of PPD in African women due to societal stigma.

• The treatment of postpartum depression include psychotherapy, rest, exclusive breastfeeding to promote bonding with the newborn, support groups, self-care and anti-depressant medications as necessary.

 

 

Introduction

 

In Africa, the birth of a child is usually a joyous occasion. It is an event filled with celebration and merriment both within the family and the entire community. So, if the new mom feels sad or overwhelmed amidst the happiness, she might be perceived as strange. Some older folks might even see her as diabolical! This is because everyone expects this to be a joyful moment. 

 

However, new moms might experience a condition called postpartum depression (PPD). PPD is significantly marked by a persistent feeling of sadness, emptiness, or hopelessness that lasts for more than two weeks after giving birth.

 

Recognizing postpartum depression can be difficult in the middle of the excitement surrounding the new birth. However, acknowledging and dealing with it is crucial. 

 

PPD indicates that motherhood can be challenging, showing the importance of being understanding and supportive of new moms. Read on to learn more about postpartum depression, including its prevalence, signs, risk factors, diagnosis, treatment, and prevention in African women.

 

 

What is Postpartum Depression?

 

It is common for women to experience the “baby blues” - feeling stressed, sad, anxious, lonely, tired, or weepy - following their baby’s birth.

 

However, some women experience a much more serious mood disorder known as postpartum depression. Unlike the baby blues, PPD doesn’t go away on its own. It can appear days or even months after delivering your baby. It can last for many weeks or months if left untreated. [1]

 

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5), defines postpartum depression as the occurrence of a major depressive episode during or shortly after pregnancy, and it is not mentioned as a separate disease. [2] It usually occurs within two to eight weeks after giving birth but can happen up to a year after your baby is born. [3]  

 

PPD is diagnosed when at least five depressive symptoms are present for at least 2 weeks. [2]

It is characterized by symptoms such as tearfulness, a feeling of hopelessness, emotional lability, feelings of guilt, sleep problems, and loss of appetite. [4]

 

 

How Common is Postpartum Depression among African Women?

 

Globally, postpartum depression is one of the most common but often unrecognized complications of childbirth that yearly affects about 10–15% of postnatal women. [4] The estimated prevalence of postpartum depression in Africa is 18.4%. However, various African countries have reported a higher rate. [4]  African women with PPD may also develop psychotic symptoms such as delusions and hallucinations (for example, hearing voices threatening to harm the baby) [5].

 

 

Symptoms and Signs of Postpartum Depression

 

The warning symptoms and signs of PPD [6] are different for everyone but may include the following that are also common in major depressive disorders:

• A loss of pleasure or interest in things you used to enjoy, including sex.

• Eating much more, or much less, than you usually do.

• Anxiety—all or most of the time—or panic attacks.

• Racing, scary thoughts.

• Feeling guilty or worthless; blaming yourself

• Excessive irritability, anger, or agitation; mood swings

• Sadness, crying uncontrollably for very long periods.

• Fear of not being a good mother.

• Fear of being left alone with the baby.

• Misery.

• Inability to sleep, sleeping too much, difficulty falling or staying asleep.

• Disinterest in the baby, family, and friends.

• Difficulty concentrating, remembering details, or making decisions.

• Thoughts of hurting yourself or the baby 

 

If these warning signs or symptoms last longer than 2 weeks, you may need help. Whether your symptoms are mild or severe, recovery is possible with proper treatment.

 

 

Risk Factors of Postpartum Depression in African Women

 

All pregnant women are at risk for PPD, regardless of age, race, ethnicity, or economic status. [4] Inadequate social support is a major risk factor that puts African women more at risk of developing PPD. [4, 7, 8]

 

Other factors include:

• A recent stressful life event such as conflicts with the partner/father of the child, financial problems, loss of job, or loss of a loved one.

• An unplanned or unwanted pregnancy,

•  Experiencing depressive symptoms, and anxiety during pregnancy. [7]

• Family history of depression/ mental illness.

• Lack of satisfaction and/or inadequate social support in the marital relationship.

• Domestic partner abuse.

• Medical complications during childbirth.

• Difficulties in feeding the baby and problems with the baby’s sleeping

 

 

Diagnosis of Postpartum Depression

 

Since doctors routinely evaluate postpartum women for a general health examination and review of family planning options at about 6 weeks after birth; they are well-positioned to identify PPD early. [9] The evaluation is done based on specific criteria.

 

To diagnose PPD, your doctor will look out for signs of depression along with losing interest in things (which is called anhedonia). Your doctor will also check for at least five other signs of depression that last for at least two weeks. You should see your doctor if you continue to feel sad and have difficulty doing your usual activities for more than 2 weeks after delivery or if you have thoughts about harming yourself or your baby. [10]

 

There are several screening tools available for identifying PPD. One of the most frequently used is the Edinburgh Postnatal Depression Scale (EPDS). [11] It is a 10-item questionnaire completed by patients and takes a few minutes. An EPDS cutoff score equal to or greater than 13 is required to determine if patients are at risk for developing PPD.

 

 

Treatment of Postpartum Depression

 

Limited information exists on treating postpartum depression in African women. Societal stigma and negative beliefs about mental health often lead them to seek help from traditional healers and religious leaders rather than psychiatrists. These points out a problem in accessing regular mental health care among African women with PPD.

 

Studies have shown that PPD can be managed with:

• Medications

• Psychotherapy

• Lifestyle adjustments

• Repetitive Transcranial Magnetic Stimulation; for breastfeeding mothers who are concerned about the effects of medicaion on their babies. It is also an offered as an effective treatment option in medication and CBT resistant patients. [2]

• Electroconvulsive therapy (ECT); for patients with severe postpartum depression who do not respond well to other standard treatments. [2]

 

 

Prevention of Postpartum Depression in African Women

 

Doctors can help reduce postpartum depression in sub-Saharan Africa countries by doing the following:

• Raising awareness and educating African women and their spouses about PPD signs and symptoms and encourage them to seek support early. 

• Encouraging prompt access to professional mental health services.

• Screening for depressive symptoms during pregnancy to identify women who are at increased risk for developing PPD for early intervention.

• Providing guidance and therapy to African women and their spouses during and after pregnancy.

• Speaking out and working to reduce societal stigma surrounding mental health issues through massive awareness creation and community engagement.

 

African women can combat feelings of depression after having a baby by doing these:

• Getting as much rest as possible. Good maternal sleep can also help in preventing PPD.

• Practising exclusive breastfeeding. Studies have shown it promotes bonding and has a positive effect on reducing depressive symptoms from childbirth to 3 months.

• Joining a social support group.

• Speaking openly to healthcare providers about your concerns and feelings.

• Creating a routine for self-care, bonding with your baby, and doing the things you love.

 

 

Conclusion

 

Motherhood in Africa can be a mix of loud joyful moments and silent battles with postpartum depression. The prevalence of PPD among African women calls for urgent need for increased public health awareness raising, improved access to mental health resources, and destigmatisation of mental health disorders. With support and understanding, African women can overcome postpartum depression and find joy in motherhood.

 

 

References

1. American Psychological Association. [Internet. n.d.]. Postpartum depression: Causes, symptoms, risk factors, and treatment options. Retrieved March 19, 2024, from https://www.apa.org/topics/women-girls/postpartum-depression.

2. Mughal, S., Azhar, Y., & Siddiqui, W. Postpartum depression. [Internet. 2022, October 7]. In StatPearls. Retrieved March 19, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK519070/

3. Unicef Parenting. What is postpartum depression? [Internet. N.d.]. Retrieved March 19, 2024, from https://www.unicef.org/parenting/mental-health/what-postpartum-depression.

4. Adeyemo, E. O., Oluwole, E. O., Kanma-Okafor, O. J., Izuka, O. M., & Odeyemi, K. A. (2020). Prevalence and predictors of postpartum depression among postnatal women in Lagos, Nigeria. African Health Sciences, 20(4), 1943-1954. https://doi.org/10.4314/ahs.v20i4.53. Retrieved from: https://www.ajol.info/index.php/ahs/article/view/202366.

5. Chika, J. Depression among African women. [Internet. 2024, January 15]. Datelinehealth Africa. Retrieved March 19, 2024, from https://www.datelinehealthafrica.org/depression-among-african-women.

6. American Psychological Association. Postpartum depression: Causes, symptoms, risk factors, and treatment options. [Intenet, 2022 Nov. 2]. Retrieved March 18, 2024. from:https://www.apa.org/topics/women-girls/postpartum-depression

7. Postpartum depression: Causes, risks, and treatment. UPMC | Life Changing n.d.]. Retrieved March 18,  from https://www.upmc.com/services/south-central-pa/women/services/pregnancy-childbirth/new-moms/postpartum-depression/risks-treatment.

8. Adama ND, Foumane P, Olen JPK, Douhbit JS, Meka ENU, Mboudou E. Prevalence and risk factors of postpartum depression in Yaounde, Cameroon. Open Journal of Obstetrics and Gynecology, 2015. 5(11), 608-617. https://doi.org/10.4236/ojog.2015.511086. Retrieved from https://www.scirp.org/pdf/OJOG_2015092114575175.pdf.

9. Sit DKY, Wisner K L. The identification of postpartum depression. Clinical Obstetrics and Gynecology, 2009. 52(3), 456-468. https://doi.org/10.1097/GRF.0b013e3181b5a57c. Retrieved from https://journals.lww.com/clinicalobgyn/abstract/2009/09000/identification_of_postpartum_depression.18.aspx.

10. Moldenhauer, J. S. (2022). Postpartum depression - Women’s health issues. MSD Manual Consumer Version. Retrieved March 20, 2024, from https://www.msdmanuals.com/home/women-s-health-issues/postpartum-care/postpartum-depression

 

Related:

• Depression among African women
• What is depression?
• Who is at risk for major depression?
• How is major depression diagnosed?
• How is major depression treated?
• Can major depression be prevented?
• Nigerians are most depressed in Africa, says WHO

 

 

 

Published: March 27, 2024

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