Before we can think about what postnatal depression is or other perinatal mental health “conditions” or “illnesses” it is important to understand the fundamentals of good mental health. Mental ill health happens when the building blocks of a good quality of life are not in place.
The PERMA™ model developed by Seligman gives a good picture of the building blocks we need for good mental well-being. Each aspect is interdependent and supports the others just like the bricks in a wall.
Positive Emotions - the experience of pleasurable emotions such as comfort, love, joy, satisfaction, happiness. Knowing how you can achieve these states.
Engagement - the ability to be in the present moment and fully engrossed in an activity. Humans have the ability to enter “flow” states where we fully engage in activities that we find challenging but enjoyable and that bring about a sense of achievement.
Relationships - connection and community. We need to feel understood and valued by others.
Meaning - We need to believe that what we do is important and that we are working towards something meaningful. This could be something cultural, spiritual, a role we play in our family or our role at work.
Achievement - We need a sense of progression and accomplishment in order to maintain focus, momentum and a sense of meaning in our lives.
Often when someone tells us they are expecting a child, or even that they are thinking of starting a family we congratulate them because we focus on the elements of PERMA™ that we expect to improve as a result of having a baby.
For example, we know that children make us laugh and often make us feel love and happiness, we imagine playing in a flow state with our children who also love baking, or lego or Star Wars, we imagine romantic relationships strengthing and bonds deepening while we bask in the sense of meaning and achievement that our offspring have brought to our lives.
None of this is ridiculous. But the parents here will know that while all of those things I’ve mentioned can and do happen there are also many moments in pregnancy and parenting that make meeting your PERMA™ needs seem very elusive.
All the reasons above can make it really hard to maintain your needs during pregnancy and parenthood.
How pregnancy and parenthood make it hard to meet our needs
Positive emotions - When you become pregnant many of the things you previously relied on to bring you positive emotional states may become unavailable to you. Depending on your health socialising, exercising, enjoying good food and many other pleasurable activities may be inaccessible. The same is true with a newborn and parents often have to adjust and find new ways of finding positive emotions as their children progress through stages and challenges and their access to their preferred activities changes. Hormonal changes may also mean that for birthing people positive emotions change for a period and for some can seem to disappear, leaving a feeling of sadness or numbness where they expected joy. Although this is usually temporary people can be so shocked and upset that they experienced this that they then develop postnatal depression.
Engagement - it can be hard to find flow state when you are exhausted or sick in pregnancy, if you usually find flow at work you might be taking time off, babies do not really allow you long enough time periods of peace to find flow and young children rarely want to engage in activities that will bring you flow.
Relationships - sleep deprivation, physical symptoms, financial pressures and changing family dynamics can all make it hard to find that connection with loved ones, including partners. Friendships that serves us well before children can also suffer.
Meaning - many of the activities that bring us meaning, such as work, and valued roles and identities are compromised when we become parents, even if only temporarily. Also during pregnancy and early parenthood it can be hard to see what we are working towards as our actions may not have a clear tangible impact. For example, you cannot see your unborn child developing and you cannot see the neural pathways in your toddler developing so the tasks of pregnancy and parenting can seem meaningless if we lose sight of the bigger picture. It is also true that society sends out some pretty confusing messages about the value of parenthood leaving many people feeling that if they are taking time away from work they are not as valuable as they once were. Unfortunately women in particular also often feel less valued if they perceive that they no longer meet beauty standards which may be impossible during pregnancy and postnatally. The pressure to “get your body back” can be seen as an attempt to become valued and meaningful in the world again.
Achievement - We have a natural drive towards achievement, a need to feel we are accomplishing things on a daily basis. Paul Gilbert a professor and the creator of Compassion Focussed therapy has argued that this “drive” for achievement has become overdeveloped in many of us and while some drive is healthy we can often become unbalanced and spend too much of our time striving for a sense of achievement which can never be satisfied. New parents often struggle with the lack of positive feedback in pregnancy and parenting and, if things do not go as they hoped or expected, this can bring about a sense of failure.
In addition, the PERMA™ model does not explicitly talk about the need for good physical health but of course, if your physical health is suffering then your mental wellbeing will also suffer. Problems such as chronic pain, pelvic floor problems, gestational diabetes, sickness, chronic sleep deprivation etc all take a huge toll on mental wellbeing and limit our overall resillence. In addition, pregnancy and the postnatal period involve big physcial changes including hormonal fluctuations that directly influence mood. While this is most pronounced and understood in birthing people men also experience hormonal changes that play a significant role.
Who is most at risk for postnatal depression and other perinatal mental health problems?
The good news is that most people find their way to good mental well-being after making the transition to parenthood, or at least back to their base level (Layard, 2023). Humans are brilliant at adapting to change and rebuilding their mental well-being.
However, a few things can make it harder for people to adapt to pregnancy and parenthood and get back to a state of good mental well-being.
Risk factors for perinatal mental health problems
Physical health problems (including HG/severe pregnancy sickness)
Traumatic birth
Unwell baby or child (including NICU)
Baby loss
History of mental health problems
Poverty
Domestic abuse/relationship difficulties
Lower education level
Perinatal substance abuse
More than one child
Child with disability (physical and/or neurodevelopmental)
For father’s specifically:
Parenting stress
Marital stress
Poor maternal mental health
It is easy to see why, all of these things make it more difficult for someone to find new ways of meeting the needs laid out in PERMA™.
Although there is not substantial research on this yet, as clinicians we also see that people who are neurodivergent, whether diagnosed as autistic or ADHD or not, often struggle in the perinatal period. We would need a whole training to talk about that but for now we can see that it makes sense that if you have any kind of additional needs getting those met during pregnancy and parenthood becomes harder and there is a likely impact on mental health.
Signs of postnatal depression and other perinatal mental health difficulties
Sadness/tearfulness
Changes in appetite
Difficulty sleeping (even when there is opportunity)
Irritability/losing their temper more easily
Socially withdrawn
Becoming overwhelmed more easily than usual
Excessive worrying about small things
Excessive exercising or other avoidance activities
Emotionally flat/seeming numb
On an emotional rollercoaster
Jumpy or “on edge”
Not engaging in activities that they previously enjoyed or prioritised
Difficulty concentrating
Difficulty making decisions
Being very hard on themselves
If you notice these signs in yourself or someone you care about that could be an indicator that some mental health support would be helpful. Often people who come to my clinic are very worried about whether or not they meet the criteria for a condition like "postnatal depression" but in fact it is much better to come forward for support before that point. Therapy can help you to work out how to get your needs met in your new circumstances.
Book a free therapy consultation now to see how our team of specialist psychologists can support you.
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Need urgent support?
We do not provide emergency services. If you or someone you care about requires urgent support with their mental health you should contact the NHS urgent support service here.