The transition to motherhood: Towards a broader understanding of perinatal distress

Abstract

Background

A substantial body of research has focused on maternal perinatal mood and wellbeing, with the focus predominantly being on depression, and to a lesser extent, anxiety. Perinatal maternal stress has also been investigated recently, but to a far lesser extent. The present paper questions whether the term ‘perinatal distress’ accurately captures the range of challenges experienced by women during the perinatal period, when the scope of ‘distress’ is limited to the experience of depression and anxiety alone.

Method

A review of the perinatal literature was conducted using several databases, to identify studies that have focused on the experience of stress as a distinct affective state in the perinatal period.

Findings

The findings of two recent studies which have employed a broader conceptualisation of perinatal distress to encompass the experience of stress as well as depression and anxiety are outlined. These recent studies have identified the experience of stress both in conjunction with and independent of depression and anxiety.

Conclusion

It is argued that future studies should investigate the concept of stress as a separate affective state throughout the perinatal period, in order to further assess how it differs from depression and/or anxiety. A more comprehensive understanding of women's experiences during their transition to motherhood, and whether ‘stress’ plays a critical role in the development and maintenance of perinatal anxiety and/or depression is needed.

Introduction

The perinatal period, which includes pregnancy and the first year post birth, is recognised as a period of major transition that can be exceedingly emotional,¹ and associated with considerable distress.2, 3 Consequently, elevated symptoms of depression and anxiety are experienced by a substantial number of women during this time, with prevalence studies suggesting that perinatal depression affects approximately 10–25% of women,4, 5, 6 and perinatal anxiety affecting approximately 25–45% of women.4, 5, 6, 7 Research has also demonstrated that depressive and anxiety symptoms are often co-morbid throughout the perinatal period3, 8, 9 and that an inter-relationship exists between the two. Furthermore, the negative consequences of depression and anxiety extend not only to the woman herself, but also to her foetus, and baby.10, 11, 12, 13, 14, 15 Given these consequences, theoretical advances that will inform intervention strategies designed to prevent perinatal depression and anxiety are warranted.

Researchers to date have predominantly defined perinatal distress as the psychological disorders of depression and anxiety that occur both during pregnancy and post birth.¹ However, it is unclear if these two affective states alone comprehensively describe the broad range of negative emotional experiences that can occur during the transition to motherhood. In this paper we argue that stress should be included in the definition of perinatal distress as a distinct affective state. The existing literature, albeit limited, that supports this premise is outlined. We also argue that further research is needed in order to assess whether maternal stress is part of a normal continuum associated with the range of physical, social, and emotional changes that accompany the transition to parenthood, or whether it is linked to a depressed mood state, or a precursor to clinical presentations. Fig. 1 depicts a proposed continuum model whereby emotional health and adjustment during the perinatal period is conceptualised as ranging from ‘Excellent Adjustment’ characterised by the presence of minimal depression and anxiety symptoms, to ‘Poor Adjustment’, characterised by clinical levels of depression and anxiety symptoms, and clear impairment in functioning. Our aim is to provide new insights to inform the design of future perinatal distress research, in order to best guide primary prevention efforts in this area.