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Treating Postpartum Depression
Postpartum Depression: Diagnosis and Treatment

Section 4
Marital Problems

CEU Question 4 | CEU Test | Table of Contents | Depression
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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In the last section, we discussed when a man becomes a father.  This has included mixed feelings, misunderstood reactions, the "easing the father’s fears" technique and a father’s two roles.

Do you have a client who is a new mother and recovering from abuse? 

In this section
, we will discuss marital disharmony, violence and depression.  This will include increased irritability, physical abuse and a lessened sense of self.  As you read, think of your client.  How does her experience with abuse affect her depression?

I’ve treated many women who mistakenly thought that their pregnancy would be the cure-all not only for their depression but also for their unhappy home life.  A troubled marriage could lead almost anyone to feel depressed.  Most people embark upon marriage assuming that it will be happy and fulfilling for both partners. 

When this does not happen, or when the happiness isn’t reciprocated, the blow to one’s self-esteem can be devastating.  If the additional stress of bringing a new life into the unhappy home is added to that situation, more often than not, it is a formula for disaster.  Pregnancy is a time when women need unconditional support from those who are closest to them.  The mother may crave attention and require her partner to validate the emotional and physical changes she is experiencing because the hormonal changes going on in her body make her particularly sensitive in pregnancy.

3 Factors of a Troubled Marriage

♦ # 1 Increased Irritability
First, have you found, as I have, that increased irritability is one of the behaviors most often associated with depression?  Although it may be simply the outward manifestation of inner sadness, the depressed woman’s husband or partner, particularly if she has not previously been depressed or if he is unaware of the many ways depression can manifest, is likely to see only her anger and irritability, not the underlying sadness. 

Because the husband is probably the person closest to her, he is also the one most likely to bear the brunt of her harsh words or short temper.  Unless he is extremely supportive and understanding, he may see himself as the innocent victim of a woman who has suddenly "gone nuts."  However the husband reacts, be it holding his tongue or lashing back in anger, any preexisting, smoldering marital tension is likely to become inflamed as the woman’s pregnancy proceeds and her depression deepens.

The husband of one of my clients actually moved out of the house during the third trimester of her pregnancy because he could no longer cope with coming home every day to what he described as an "emotional hurricane."  Luckily, once both he and his wife understood that her radical personality transformation was a symptom of depression rather than a normal aspect of pregnancy, he was able to put his own feelings aside in order to support her, and he subsequently moved back in.

♦ #2 Physical Abuse
Second, if marital discord increases a woman’s risk for postnatal depression, actual abuse or physical violence creates a situation that can explode into an emotional tsunami during pregnancy.  Some of my own clients have actually reported being kicked in the stomach during pregnancy, as if their abusers were trying to hurt not only them but also the babies they were carrying.

And what about the women who are being abused?  They are often as beaten down mentally as they are physically battered and bruised, and because they are depressed, they may feel hopeless and are totally lacking in self-esteem. They are unlikely to see any way out, particularly when they are about to have a baby and may, therefore, feel more dependent financially on their partner and believe that they won’t be able to survive on their own with a new baby. 

They don’t report the violence because they believe it is somehow their fault and that they will be blamed for what’s happening to them if anyone else, including their health care provider, finds out.  The onus, clearly, falls on the health care provider to ferret out the information in a way that will allow the woman to confide in him or her.

Marissa, age 17, came to me when she was seven months pregnant.  Although Marissa had a history of depression, her symptoms were presently in remission.  Like many teenagers, she had abused drugs to help alleviate her depression, but she assured me that she’d been clean throughout her pregnancy.  What she didn’t tell me, however, was that her partner, Art, whom she’d met at a Narcotics Anonymous meeting just eight months earlier, was still using narcotics in the form of prescription pain-killers.

Since Marissa’s depression and drug abuse made hers a high-risk pregnancy, I asked that she and Art come in together for a prenatal assessment.  When I met Art, I had a strong gut feeling that he could be violent.  I didn’t ask him directly if he was abusing Marissa, but I did manage to discover, through cautious questioning, that he was still struggling with drugs.

It was not, however, until her final postnatal visit that Marissa described to me the physical violence to which she’d been regularly subjected throughout her pregnancy.  At that point, I alerted the appropriate child welfare agency so that they would be able to monitor the situation, but even so, just eight weeks after she gave birth, I received a telephone call informing me that Marissa and the baby had been admitted to the hospital with multiple injuries.

Both Marissa and the baby recovered from their physical injuries.  The baby was put into foster care, and Marissa now visits with her frequently, trying to form a bond in anticipation of the day when, she hopes, her daughter will be returned to her.  But it was not until her situation was out in the open that Marissa could bring herself to tell me she’s been, as she put it, "scared to death of Art the entire time she was pregnant."

♦ #3 A Lessened Sense of Self
Third, in addition to increased irritability and physical abuse, let’s discuss a lessened sense of self.  Although Marissa’s case is extreme, and in most cases the abuser does not directly attack his own child but confines his violence to attacking his partner or spouse, Marissa’s inability to seek help or to leave the relationship, as you know,  is not so different from what happens to any woman who is regularly subjected to physical abuse.  Living with violence almost inevitably erodes the woman’s sense of self, and the longer the violence continues, the less likely it is that she will be able to extricate herself from her untenable situation. 

Moreover, speaking specifically of the external factors that put women at greater risk of postnatal depression, it is obvious that domestic violence would be one of the key stressors.  It may also be important to note that even if the abuser does not harm the fetus or the baby directly, research has shown that any child brought into an environment filled with rage, fear, and tension is at great risk for developing serious psychological problems later on.

Do you have a Marissa?  Might she benefit from hearing this section? 

In this section, we have discussed marital disharmony, violence and depression.  This has included increased irritability, physical abuse and a lessened sense of self.  Would playing this section be beneficial during your next session with a client you are currently treating?

In the next section, we will discuss loss and depression.  This will include mothers who lose mothers and the confluence of causes regarding depression.

Peer-Reviewed Journal Article References:
Brandão, T., Brites, R., Pires, M., Hipólito, J., & Nunes, O. (2019). Anxiety, depression, dyadic adjustment, and attachment to the fetus in pregnancy: Actor–partner interdependence mediation analysis. Journal of Family Psychology, 33(3), 294–303.

Cao, H., Zhou, N., Leerkes, E. M., & Su, J. (2021). The etiology of maternal postpartum depressive symptoms: Childhood emotional maltreatment, couple relationship satisfaction, and genes. Journal of Family Psychology, 35(1), 44–56.

Dellagiulia, A., Lionetti, F., Pastore, M., Linnea, K., Hasse, K., & Huizink, A. C. (2020). The Pregnancy Anxiety Questionnaire Revised-2: A contribution to its validation. European Journal of Psychological Assessment, 36(5), 787–795.

Lavner, J. A., Karney, B. R., & Bradbury, T. N. (2014). Relationship problems over the early years of marriage: Stability or change? Journal of Family Psychology, 28(6), 979–985.

Jensen, J. F., & Rauer, A. J. (2015). Marriage work in older couples: Disclosure of marital problems to spouses and friends over time. Journal of Family Psychology, 29(5), 732–743. 

Tu, K. M., Erath, S. A., & El-Sheikh, M. (2016). Coping responses moderate prospective associations between marital conflict and youth adjustment. Journal of Family Psychology, 30(5), 523–532. 

Online Continuing Education QUESTION 4
What are three stages of marital disharmony? To select and enter your answer go to CEU Test.

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