Symptoms and Risk Factors

Clinical signs and symptoms of anxiety, depression and stressor or trauma-related disorders

It is important to remember that some anxiety, worries and some changes in routine around eating and sleeping are normal aspects of adjusting to parenthood. However, the following list includes symptoms that can have a significant impact on quality of life and functioning.

If a parent experience several of these symptoms over a two-week period or more and affecting daily life, they may be vulnerable to or experiencing a depressive or anxious episode.

Symptoms of anxiety, depression and stress

·   Reduced enjoyment in activities that previously brought enjoyment.

·   Memory, concentration or decision-making difficulties.

·   Increased irritability or reactivity to others.

·   Physical symptoms that were not previously present such as heart palpitations, chest tightness, headaches, body tension, sweaty hands, tingling, shortness of breath, stomach aches.

·   Sleep and appetite disturbance.

·   Feeling numb, hopeless or despairing about the future.

·   Feeling separate, remote or withdrawn from family and friends.

·   Feeling out of control or ‘crazy’.

·   Unable to rest when the baby is sleeping including difficulty getting to sleep and/or difficulty getting back to sleep after baby has resettled.

·   Nightmares and/or flashbacks of upsetting birth events.

·   Avoiding situations that remind you of the birth.

·   Scary, unwanted, recurrent thoughts or images of something bad happening to themselves, their baby or those around them.

·   Frequent feelings of worthlessness or excessive guilt.

·   Frequent grief, loss, tearfulness.

·   Fatigue and loss of energy.

·   Feeling more angry than usual, experiencing frequent angry outbursts that are out of character.

·   Repetitive negative thought patterns often including harsh self-criticism.

·   Regular anxiety about the need to stick to rigid routines.

·   Recurrent thoughts of suicide, wanting to die, wanting to escape or thinking about going to bed and never waking up.

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Clinical definition and symptoms of trauma-related disorders

 A parent (mother or partner) may experience or witness an event they find traumatic in the perinatal period such as a difficult or complicated labour or birth, a medical emergency for parent or baby after birth, miscarriage, ectopic pregnancy, stillbirth or neonatal loss.

Sometimes labour or birth may not involve medical trauma but can still be psychologically traumatic for a parent if they feel disempowered, ignored, ill-informed or out of control.

For some people, this trauma will resolve over time without intervention. Some parents may find it helpful to talk about the event, feel supported and heard by others and be able to process emotions associated with the trauma. Not all people who witness or experience a traumatic event will develop a trauma-related disorder, but some do.

Some however, may also develop a trauma-related disorder indirectly by hearing or learning about a traumatic event.

Acute stress disorder can occur immediately after a traumatic event and is a short-term condition often lasting only up to a month. A person who has ASD experiences psychological distress and its symptoms are similar to PTSD as explained below. ASD is a temporary condition, and treatment focuses on decreasing symptoms, improving coping strategies and preventing PTSD. In dealing with ASD, talking to family and friends and seeking community support is often enough to deal with the effects of trauma if it is not complicated or perceived as life-threatening. If symptoms are ongoing however it can develop into PTSD.

The most widely recognised trauma disorder is post-traumatic stress disorder commonly referred to as PTSD.

Some of the following symptoms may contribute to a perinatal PTSD diagnosis if they are distressing and do not start to recede several weeks after birth:

Symptoms trauma-related disorders

• Re-experiencing the trauma through vivid and distressing flashbacks or dreams.
• Negative thoughts and feelings such as fear, anger, guilt, feeling flat or numb a lot of the time, thinking they are to blame for what happened.
• Being in a constant state of ‘alertness’ – watching out for danger to themselves, their baby or other loved ones.
• A stress response to noises, smells or sights that remind them of the traumatic event.
• Avoiding particular places or situations that may evoke reminders of the traumatic event for example not wanting to drive near the hospital.

If a parent has one or more previous significant experiences of trauma, they are more vulnerable to PTSD in the perinatal period. These include sexual trauma, childhood abuse, bereavement of a significant person and family violence, previous adverse birth or pregnancy-related events.

Date of Last Review: April 2021

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Risk Factors

What Helps or Hinders in the Perinatal Period

The conception journey or when becoming a parent is a time of huge change, challenge and excitement. This transition can place significant pressure on how a person manages stress and increases demands on the whole family’s emotional, physical and material resources. There can be joy as well as overwhelm. This overwhelm can sometimes increase to clinically significant distress that needs more attention and care.

Everyone is vulnerable when a baby is coming along – first time parents, those who’ve journeyed down this path before, parents from all socioeconomic and cultural backgrounds as well as non-biological parents and other carers such as foster/adopted parents. Mental illness does not discriminate. In fact, In Australia, 1 in 5 women and 1 in 10 men will experience some form of perinatal depression and anxiety.

We all have stories and vulnerabilities that have an impact on us, as well as strengths that can help in difficult times. If distress is escalating into perinatal depression or anxiety, it is usually because of a combination of biological, psychological, social and cultural factors.

Vulnerabilities include:

• Past or current personal/family history of mental health problems or substance use issues.
• Past or current trauma, abuse or other stressful experiences.
• Relationship difficulties and social isolation.
• Unresolved losses or abuse from childhood.
• Compromised attachment from our own parents, particularly our mothers in childhood.
• Previous perinatal/pregnancy loss or conception difficulties.
• Birth of twins or multiples/financial difficulties and limited access to social and practical supports.
• Financial difficulties and limited access to social and practical supports.
• LGBTQI+ parents, who face discrimination and lack of support.
  Aboriginal or Torres Strait Islander or CALD without access to culturally aware support systems.

Factors that assist recovery

Strengths that are protective and could assist in recovery include:

• Reliable, safe and consistent supports particularly with a partner or close family member.
• Adaptive coping strategies such as: emotional awareness and regulation, capacity to self-care and distress tolerance.
• Consistency of care and collaboration in decision making during pregnancy.
• Financial security.
• Help seeking behaviours and access to appropriate resources/services.
• Supportive workplace arrangements.

Any new or expectant parent can be affected by perinatal depression and/or anxiety, even in the absence of risk factors and presence of protective factors. It is useful to know what both are and to get help as early as possible. If you are not feeling yourself and nothing is helping for two weeks or more, we encourage you to reach out to a trusted friend/family member or health professional to get the support you need.

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Date of Last Review: December 2021