What is Post-natal depression (PND)?
Post-natal depression (PND) is a very common mental health condition affecting women after childbirth. Some studies have shown that up to 13% of mothers suffer from PND, with mothers being at greatest risk of developing PND within the first three months after childbirth (Dennis., 2005; Norman, et al., 2010). PND is caused by a number of variables. Aside from hormonal changes that affect the limbic system and other regions in the brain responsible for our mental health, there are also psychosocial factors that affect how we feel. These might include weight gain, sleep deprivation, changes in lifestyle, lack of social support, stress, and perceived sense of control (Pivarnack, et al., 2006).
Along with Psychotherapy, exercise is a proven effective treatment that helps to reduce symptoms of PND but also reduce the risk of developing PND. Exercise has positive impacts on self-esteem, physical strength, weight-loss and improving energy levels. Regular exercise also improves sleep, reduces stress and improves general wellbeing. Many of the studies which currently examine the impact of exercise on PND use the Edinburgh Postnatal Depression Scale (EPDS) to evaluate mental health of mothers. The EPDS is a validated questionnaire used to evaluate how you have been feeling and can be used during pregnancy and after.
The questionnaire asks you to select the most appropriate answer that represents how you have been feeling over the past seven days. Answers may include 'all the time, some of the time, not very often, and not at all'. You can link to the questionnaire by clicking on the heading above. Below are the questions that are asked in the questionnaire.
- I have been able to laugh and see the funny side of things.
- I have looked forward with enjoyment to things.
- I have blamed myself unnecessarily when things go wrong.
- I have been anxious or worried for no good reason.
- I have felt scared or panicky for no good reason.
- Things have been getting on top of me.
- I have been so unhappy that I have had difficulty sleeping.
- I have felt sad or miserable.
- I have been so unhappy that I have been crying.
- The thought of harming myself has occurred to me.
If after reading this information you are beginning to wonder if you suffer symptoms of PND, I would urge you to seek a professional opinion from your doctor. Beyond Blue, the Australian charitable foundation dedicated to helping those with depression and anxiety, offer many resources for clinicians and the general public.
You can take the test if this is something you’d prefer to do before seeking help. It’s also a good way to understand what some of the signs of post-natal depression are so that you can monitor your mental health. It is not a diagnostic tool but rather a screening test for the risk factors in developing PND. The international cut-off score is 13 (out of 30) for depression, but many publications suggest that a score above 9-10 should warrant further review and assessment from a trained medical practitioner.
While exercise is effective in reducing the risk of developing postnatal depression, the most “promising intervention is the provision of intensive, professionally based postpartum support” (Dennis, 2005, p.1). If you feel that you are experiencing symptoms of PND or now recognise that a close friend or relative might be, reach out for support from your doctor or treating healthcare practitioner. Mothers who develop PND are at much higher risk of future episodes and it also has an impact on child development through impairment of the mother-child bond. PND is not something to be ignored or overlooked.
Exercise and postnatal depression
The reason I’ve chosen to write a section on postnatal depression is to draw attention to the signs and symptoms of PND and to discuss briefly how exercise is used as a treatment of postnatal depression.
In 2010 a study was published by Physical Therapy, and it was the first high quality research trial to demonstrate how exercise reduces the risk of developing postnatal depression. It was a study conducted in Melbourne, Australia, that looked at the impact of an 8-week supervised exercise program combined with education for new mothers, compared to education alone. The participants were healthy mothers with no history of mental health conditions. The program consisted of 1 hour a week of exercise combined with 30 minutes of education about toys, baby massage, nutrition for mothers and other topics. The results were extremely positive. They showed that the number of women identified ‘at risk’ of developing PND reduced by 50% in the group that had exercise and education. What this means is that exercise has a very positive impact on mental health and physical wellbeing (Norman, Sherburn, Osborn, & Galea., 2010).
As motivated as you might be to exercise at home, please never forget the importance of surrounding yourself with a social network. The most ideal situation is to be involved in a group exercise class that allows for babies to be present, mothers to interact and socialise, while learning about safe and suitable exercises after child birth. A Japanese study found that one of the biggest risk factors for developing PND is social isolation. This study showed that 72% of Japanese mothers stay home with their children which results in a degree of social isolation (Hurana., 2013) . One of the major benefits of a post-pregnancy mothers group or exercise program is the ability to connect mothers and provide an exercise environment where babies are welcome too.
Personally, I’ve witnessed the positive impact of this program design. For the study by Norman et al (2010) I was one of the therapists guiding this program for several months during my Women’s health rotation at the Angliss Hospital, Ferntree Gully. It was encouraging to see so many mothers transform over the eight weeks and they all left the program with valuable knowledge and skills for running their individual and independent exercise. Many of the mothers stayed in contact and would run their exercise groups long after they finished the program. Many of the exercises that I use in my Women’s health programs today, come from the experience I gained while teaching on this program.
Participation in regular exercise has such a positive impact on physical and mental health. Hopefully the information presented here reinforces how important it is. If you don't know where to start, try going for regular walks for 30 minutes or more at least 3-4 days a week. In total you should aim for 150 minutes of exercise per week. It is not always easy to participate in a regular group exercise program, not matter how much you may wish to, but that doesn't stop you from being able to exercise at home. Below are a few suggested exercises that can be done at home. Stay tuned for some more recommended programs :)
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Dennis, C. L. (2005). Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. Bmj, 331(7507), 15.
Eberhard‐Gran, M., Eskild, A., Tambs, K., Opjordsmoen, S., & Ove Samuelsen, S. (2001). Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatrica Scandinavica, 104(4), 243-249.
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