perinatal moodResearch findings have been quite consistent: the risk factors for developing a mood or anxiety disorder during or post-pregnancy are universal, and can be readily identified. While there seem to be many risk factors on the list, the good news is that being aware of them can lead to early detection and treatment of Perinatal Mood and Anxiety Disorders (PMAD). If you know you are at high risk, you can not only take steps to reduce the risk, but you can be

more on the lookout for symptoms as well as have a treatment plan in place for a quicker road to recovery.

Many people mistakenly assume that a mood or anxiety disorder that is pregnancy-related must be a result of hormones. While hormone fluctuation can play a role, it is by no means the only thing that contributes to PMAD. There are other biological/physiological risk factors, as well as psychological ones. Additionally, there are social/environmental related risk factors that the research has shown to play a role in the development of PMAD. Lastly, there are what are considered exacerbating factors. These are not risk factors per se, but they have a clinically relevant relationship to these disorders, and as such we would do well to keep an eye on them. They might not cause a mood or anxiety disorder, but if you are already at risk, they could tip the balance and make things worse.

Biological/Physiological Factors

  • Previous strong reactions to hormonal changes
    • Puberty, PMS, PMDD, hormonal birth control
  • Hyperemesis Gravidarum during pregnancy 
    • A severe form of morning sickness that leads to weight loss and dehydration
  • History of fertility treatment
  • Endocrine dysfunction
    • History of thyroid imbalance
    • Other endocrine disorders
    • Diabetes
  • Exacerbating biological/physiological factors
    • Pain
    • Lack of sleep
    • Abrupt discontinuation of breastfeeding

Psychological Factors

  • History of PMAD
    • Within your family
    • Within your own pregnancies
    • Symptoms beginning during pregnancy
  • Previous mood or anxiety disorders
    • Either within your family or your own history of anxiety, depression, bipolar, OCD, or eating disorders
  • Exacerbating psychological factors
    • Previous losses through miscarriage, neonatal death, stillbirth, abortion
    • Complications in pregnancy (such as bed-rest), birth (such as emergency c-section), or difficulty with breastfeeding
    • History of childhood sexual abuse
    • High expectations of oneself, a perfectionistic personality
    • Low self-esteem

Social/Environmental Factors

  • Lack of social support
  • Feeling isolated, living far from family/friends
  • Interpersonal violence
  • Big upheavals
    • Loss/change of job
    • Move, change of residence
    • Loss of person close to you
    • Divorce
    • Financial hardship
  • High stress parenting
    • Military
    • Multiples
    • Single parents
    • Teenage parents
  • Exacerbating social/environmental factors
    • Baby admitted into NICU
    • Special needs baby
    • Colic/difficult temperament
    • Childcare stress
    • Marital trouble

While this seems like a long list, keep in mind that those “exacerbating” factors are not stand-alone risk factors. “Risk” implies the something that can give rise to a negative outcome, whereas “exacerbating” implies a factor that can make something that’s already happening worse. Additionally, we are all very different individuals. Someone may have many risk factors, but come through a difficult delivery feeling stressed but okay. Another person may have only one or two risk factors, and yet feel very traumatized by the pregnancy or birth experience. This is not meant as a checklist that should directly correlate the number of items checked off with the likelihood a person will develop a mood or anxiety disorder during or after pregnancy. At the same time, if you note a number of risk items in your life, you may be able to work on ways to reduce the risk, watch for symptoms, and/or create a treatment plan ahead of time, just in case. My next article will address these issues. Stay tuned.

If you feel it is time to seek help for your symptoms, please don’t hesitate. Untreated Perinatal Mood and Anxiety Disorder can have long term and adverse implications for parent, child, and family.  

You can contact a therapist, counselor, or social worker. We offer PMAD counseling services at the Adult Therapy and Cohesive Families Institute. You can also contact your OB/GYN for screening. You can contact a psychiatrist. You can contact Postpartum Support International through their helpline at 800-944-4773 or postpartum.net for support in your area.

“You are not alone. You are not to blame. With help, you will be well.”

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