France’s weekly epidemiology record (BEH) recently published a study on the prevalence of postpartum depression, anxiety, and suicidal ideation in women at 2 months after giving birth.
The report reveals that in 2021, 1 in 6 women at the had postpartum depression 2 months after giving birth, more than a quarter had a significant level of anxiety, and 1 in 20 women had suicidal ideation. These results tally with international data on perinatal mental health.
The data come from France’s 2021 national perinatal survey (ENP 2021), which was carried out on a representative sample. The survey has been conducted for more than 30 years in women in the maternity ward and 2 months after birth. It provides an overall picture of perinatal health in France. This is the first time that this type of survey has focused on the mother’s mental health.
Large Sample Size
The study involved 7133 women who gave birth in metropolitan France over the course of a given week in March 2021 and who completed the 10-question self-administered Edinburgh Postnatal Depression Scale (EPDS) questionnaire at 2 months postpartum. A score of 13 or higher (on a scale of 0 to 30), indicating the risk for depression, was reported in 16.7% of the women. “It’s a rather high number and also quite worrying: an EPDS score of 13 or more at 8 weeks after giving birth means that the mother was unwell long before and that it was not picked up on,” Anne-Laure Sutter, MD, PhD, a psychiatrist and head of the perinatal psychiatry network at Charles Perrens Hospital in Bordeaux, France, told Medscape Medical News.
“Screening for and identifying risk factors for postpartum depression must be done in early pregnancy and then immediately after giving birth and going home,” she insisted.
Romain Dugravier, MD, child and adolescent psychiatrist at the Center for Perinatal Psychopathology, Paris Brune Institute, explained that these issues are not being picked up in women because of inadequate training of front-line professionals (that is, midwives and obstetricians), a lack of structured screening strategy, feelings of shame and guilt experienced by mothers in asking for help, and the unwillingness of a new mother’s close family and friends to spot and understand the distress she often faces.
“Healthcare professionals also often find it difficult to commit to screening when they have no solution to offer their patient. As for women, they say that they are afraid of being offered medication as a first resort,” Dugravier told Medscape. There are many obstacles to overcome in order to improve the situation.
The investigators have also noticed regional disparities: some regions (Hauts-de-France, Grand Est, Bourgogne-Franche-Comté, Nouvelle-Aquitaine) have significantly lower rates of postpartum depression than the national average, while others (Ile-de-France, Centre-Val de Loire, and Provence-Alpes-Côte d’Azur) have higher rates.
“The Grand Est and Hauts-de-France regions have very active clinics that offer early screening,” Sutter explained.
“There are no clear reasons to explain these differences. That said, we know that there is a growing trend for postpartum depression linked to certain socioeconomic criteria,” said Dugravier.
At the Paris Brune Institute, women who have just given birth complete the EPDS during their stay on the maternity ward. “The EPDS isn’t perfect and doesn’t put forward a simple diagnosis, but it helps us to open a dialogue,” said Dugravier.
The prevalence of anxiety was 27.6% overall and 83.2% among women presenting with postpartum depression. A regional disparity in anxiety was also observed, with significantly lower rates in Normandy and Nouvelle-Aquitaine and higher rates in the Centre-Val de Loire and Provence-Alpes-Côte d’Azur regions.
Breaking the Taboo
“For a long time, French women weren’t asked about suicidal ideation as part of postpartum depression studies, unlike in, say, the United Kingdom or the United States, where it was shown that suicidal ideation does indeed exist in new mothers,” said Sutter. “France removed death by suicide from maternal mortality figures,” despite the status of suicide as the leading cause of maternal death in the postpartum period.
According to the ENP 2021 estimates, the prevalence of suicidal ideation (item 10 of the EPDS ≥ 1) was 5.4% overall and 23.8% among women with postpartum depression. “I think that the proportion of women in the postpartum period with suicidal ideation is actually even higher than this. There is still an element of social desirability bias in answers to self-administered questionnaires,” said Sutter, who is happy that the taboo is beginning to be dismantled.
“These results are slightly below those reported in the latest meta-analysis published to date (7%),” wrote the investigators in the weekly record.
For Dugravier, “a safe space has been opened” where discussions about postpartum depression and suicidal ideation can be held openly. “Increasing numbers of women come to us asking for help,” he said. And treating them is crucial, because postpartum depression adversely impacts individuals, couples, and childhood development.
“Children in families where one parent is depressed during their childhood are more susceptible to anxiety, depression, and behavioral issues,” said Dugravier.
This article was translated from the Medscape French Edition.
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