Women in urban areas at higher risk of postpartum depression: study

TORONTO – Giovanna Vaccaro’s six-month-old daughter, Emma, likes to sing with her mom, explore toys, and sit outside listening to the birds in the trees.

“She’s a joy,” said Vaccaro. “My husband and I feel very blessed that she came into our lives.”

But Vaccaro didn’t always feel excited about her new baby.

After what she described as a normal pregnancy, Vaccaro was kept in hospital for a week after Emma’s birth—the newborn had jaundice and there was initial concern of respiratory issues.

“For the first two weeks, I didn’t sleep hardly at all,” said Vaccaro. “And I think that was a major factor, a major stressor that led to the postpartum depression.”

Read more: What is postpartum depression?

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The Toronto mother said it took her between two and three weeks to realize there was something wrong—it started with the lack of sleep, but soon turned into anxiety and a loss of appetite.

Her husband was traveling for work soon after their daughter’s birth, but a friend who came to stay at the house and an aunt who was visiting from Montreal noticed that she wasn’t quite herself.

“I felt like I wouldn’t be able to take care of the baby’s needs,” she said. “Eventually I started having some negative thoughts…thoughts about either hurting myself or the baby. I never acted on them, but when those kinds of thoughts came into my head, I had to push them away. And that’s when I knew I had to get help.”

According to a new study, Vaccaro is one of many urban moms who are at an increased risk for postpartum depression.

Women’s College Research Institute scientist Dr. Simone Vigod looked at data from more than 6,000 mothers as reported in the 2007 Maternity Experiences Survey. Vigod found that differences in risk factors, including place of birth, social support and history of depression in combination with geographic location can contribute to postpartum depression.

While it may seem counterintuitive, the study found women in urban areas with the highest population reported less social support than those in rural areas.

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“What we hypothesized is what’s happening in smaller areas is there’s actually more support because there’s more access to family—it’s a much more family-oriented culture,” Vigod told Global News. “Whereas in large populations, there are pockets of isolation…people are moving away from their families, working long hours, they have long commutes, and maybe their partners aren’t around as much.”

When the data was broken down into “semi-urban” and “urban” areas, researchers found that women in semi-urban areas reported the highest rates of another risk factor: history of depression. But the women in semi-urban areas had lower rates of postpartum depression compared with urban women.

“It actually suggests there’s something going on in these semi-urban areas to mitigate the risk,” said Vigod, noting that postpartum depression is generally thought of as biologically, psychologically and socially mediated. “In this study, even though women in urban areas reported less history of depression, it’s almost like the lack of social support really drove the increased risk.”

Another interesting finding: women in the study who were Canadian-born were at a lower risk of experiencing postpartum depression, compared to women who were not. Vigod says this is not a genetic difference, but instead suggests it may be that women who aren’t Canadian-born could have problems getting social support.

“They may not be as engaged with the healthcare system in terms of getting care prior to delivery, so they may be less well-treated in terms of their depression prior…which can increase their risk of postpartum depression,” Vigod said. She says women who are recent immigrants who’ve married someone and moved far away from their families could be at increased risk since the mother’s family is often a strong source of social support.

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Vigod believes that supports and services need to be better targeted towards women based on their location in order to reduce the risk of postpartum depression. She says different services are available across Canada, like public health nurses sent into homes with new mothers after delivery in Ontario, for example.

With services available, why are women in urban areas falling through the cracks?

Vigod thinks there needs to be more awareness that these women may be at increased risk—particularly those who are not-Canadian born or those with lower social support—and suggests screening, and making sure healthcare pathways are available.

“There’s no point in identifying women who are at risk if there’s nowhere to send them, so identifying where they can go, and using our public health resources wisely, so we can actually make sure women who need those services are getting them.”

She also points to the need to investigate barriers: “Is it possible certain cultures aren’t amenable to having a public health nurse come into their home to increase support? Maybe it needs to be peer or community support…we need to be looking in different directions,” she said.

Vaccaro, born and raised in Montreal, but now living in Toronto, said her turning point was when she visited her obstetrician/gynaecologist (OB/GYN) at a six-week follow up appointment after Emma’s birth.

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“He asked me, ‘how are you doing?’ And I said, ‘well I’m feeling totally overwhelmed, and very anxious,’” recounted Vaccaro. Between a choice of heading to the emergency room or a referral to Women’s College Hospital, Vaccaro chose the referral and saw an intake nurse within a day, who eventually matched her with Dr. Vigod.

Vigod adds that one of the largest risk factors for postpartum is having depression in pregnancy—especially if left untreated. She notes many mothers have trouble weighing the risk of untreated depression with taking anti-depressants during pregnancy, and is currently researching non-pharmacological treatment for depression in pregnancy, as well as developing patient aids to help with difficult decisions new mothers face.

She believes the most important thing for women who feel they may be experiencing postpartum depression—a symptom of which is also significant anxiety—is to talk to their family doctor or healthcare provider.

“It’s not just something you’re supposed to suffer through, and then you’ll be fine postpartum,” she said. “You actually may be causing problems for your baby, yourself and the relationship long-term.”

Vaccaro agrees with this advice—and noticed positive changes within two weeks of starting prescribed medication.

“I’m able to enjoy my child and to parent her,” she said. “It’s a wonderful experience now, whereas the first couple of months, it was just…it was not.”

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She says she understands that many people might think of postpartum depression as baby blues that will pass, and suggests new moms might hesitate to reach out for help for fear of what will happen next.

“If you admit you need help, you think…What’s going to happen to the baby? You don’t want the baby taken away or anything like that, so that’s why I think a lot of women hesitate. And I think as women, we shouldn’t worry about that, we shouldn’t judge one another, we should help each other and encourage each other,” said Vaccaro, who points to the recent Lisa Gibson tragedy as an urgent example of the need to “eliminate the stigma” associated with postpartum depression.

Read more: The Gibson family tragedy

“There’s no reason that mothers and children should have to die, especially not in our country where we have our healthcare system that can provide treatment that helps and makes it possible for you to mother your child and to enjoy it, to make it a positive experience,” she said.

Vaccaro believes we need to increase awareness of what she calls the “vast continuum” of postpartum depression symptoms, and urges women to talk to a friend or doctor to get the help that’s needed.

“We need to educate new moms and their family members (or whatever support group they have) to recognize the signs, and to try to get that help as soon as possible. Because treatment is available and it does make a huge difference,” she said. “At least it did for me.”

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WATCH: New research suggests postpartum depression is influenced by factors tied to where women live, with new mothers in urban areas at an increased risk. Simone Vigod, study author and psychiatrist at Women’s College Hospital, explains symptoms of postpartum depression and the findings of her study.