By RAJ PERSAUD CONSULTANT PSYCHIATRIST
A team of psychologists and psychiatrists based in Israel, have just published a fascinating study examining whether women who adopt are prone to a kind of post-natal depression. Just as women who deliver a baby biologically are said to be prone to.
The study lead by Yehuda Senecky and Alan Apter, with other colleagues, based largely at Tel Aviv and Bar Ilan Universities, surveyed almost 40 women before, and six weeks after they had adopted.
The intriguing finding was that the rate of depression in women who adopt just after the adoption is around 15%, which is almost exactly the rate of depression found in women who have given birth. The authors of this study suggest this is powerful evidence that the key mechanisms by which women develop post-natal depression must be more psychological and social rather than biological.
Controversy has raged about the precise causes of post-natal depression even long before the disorder was officially recognized (only as recently as 1994 did “depression of postpartum onset” officially appear in the formal psychiatric dictionary of diseases The Diagnostic and Statistical Manual of Mental Disorders).
Many doctors and experts in this field have contended that it’s the massive physiological changes which occur often abruptly around delivery and following pregnancy which account for the high rate of psychiatric disturbance in women shortly after delivery.
On the other hand others have suggested that there is a danger in ‘over-biologizing’ the condition. They suggest, instead, its perfectly understandable given all the stresses a new mother faces, that at this time of emotional turmoil, she should be prone to psychological problems.
The psychology of the situation includes the ‘intra-psychic’ dimension of how an individual mother reacts to and copes with her new child; as well as the wider social psychology of the predicament, involving the support she gets from those around her and their reaction as well to this event.
The more psychologically minded researchers in the field argue that it’s the crucial stress of ‘transition to parenthood’ which really underlies the cause of post-natal depression.
Alan Apter’s team in Israel suggest that putting aside the pregnancy itself, parents who adopt undergo many of the same difficulties in this ‘transition to parenthood’ as biological parents. Given approximately one in 40 children are now adopted in many parts of the Western world this is an increasingly common way by which families arise.
Adopting parents, contends the Israeli team, may also be subject to additional unique and potentially stressful hardships that might make their ‘transition to parenthood’ indeed more of a strain than becoming a ‘biological’ parent. Additional problems which adopting parents face that biological ones don’t, include coping with the inability to conceive and the difficulties engendered in the whole infertility journey. Then having surmounted those they next face agency evaluations of parental fitness, the uncertain wait for an eligible child, the adoption experience itself, and in many parts of the world, possible continuing social stigma.
Those who are brought into the world in the ‘taken for granted’ background of a family history and knowledge of that, may forget that adopting parents, given the lack of genetic heritage experience, also face the stress of the uncertainty of potential medical, developmental or biological problems of the adopted child.
Perhaps then, given these predicaments it should come as no surprise that the Israeli team found that adopting mums may experience the same rate of depression as biological mothers. Yet this rate was significantly less than the rate of depression this group was prone to before the adoption. The rate of depression in parents hoping to adopt, before adoption, was a staggering 25%. According to this study then the arrival of a child and the facing of the so-called stressful ‘transition to parenthood’ produced a startling fall in depression rates by 10%.
The authors of this new and important study conclude that their results of this new study indicate that there is no significant difference in the incidence of depression between adoptive and birth mothers. They argue this finding ‘negates the widespread assumption that postpartum depression is a direct consequence of the many and varied physiological changes that occur during pregnancy and delivery’.
Whilst many in the field may take issue with such a categorical statement there is a deeper almost philosophical point being made by this unique and valuable research about the very nature of stress.
For parents trying to adopt the arrival of a child brings with it all the stresses of the infamous ‘transition to parenthood’, and yet this event or predicament is associated with dramatic drops in rates of depression. You could almost call it a cure for depression!
So in one case someone’s stress is another’s panacea.
This suggests that stress is not something objectively ‘out there’ but is much more embedded in our interpretations of what is happening to us, and the meaning of the event. If something we are desperate for has at long last happened to us – we tend to hurdle the stress and indeed not even regard it as such.
This notion has important implications for treatment. It means that the psychological help offered to mother suffering from post-natal depression or indeed anyone suffering from stress, must include an attempt to understand their interpretation of the event as a stressful or negative one.
It shows also, terrifically positively, that we are able to cope with enormous stress depending on our approach to it. This has to be good news for all suffering from psychiatric and psychological problems, including in particular new mums.
Post-adoption depression among adoptive mothers
Journal of Affective Disorders, Volume 115, Issues 1-2, May 2009, Pages 62-68 Yehuda Senecky, Hanoch Agassi, Dov Inbar, Netta Horesh, Gary Diamond, Yoav S. Bergman, Alan Apter