Why Does Postpartum Depression Happen: Essay

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The adverse effects societal changes such as urbanization have on the incidence of Postpartum Depression and measures taken to support women.


With the incidence of Postpartum depression (PPD) at around 20%, this paper aims to explore how a current stressor such as urban upbringing (a factor that has not yet been studied about PPD could affect the incidence of PPD). It expands on the hypothesis that urban upbringing is linked to increasing stress hence a potential increase in PPD incidence. Moreover, the paper provides evidence-based methods to support women suffering from PPD such as hardiness training. Furthermore, solutions such as management of PPD and ways to overcome limitations when carrying out studies are also provided. Due to these limitations, when studying the effect of different risk factors on PPD, more research has to be done which includes multivariate and multifactorial models.

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In a world that's rapidly developing it is evident that human lifestyle has changed among several cultures (Lambert, 2006). These lifestyle changes have undoubtedly improved the quality of life of so many, yet there seem to be some adverse effects -stressors- arising amongst today's society that previously weren't considered aggravators. Despite the major medical advancements that have occurred in pharmaceutical companies that produce antidepressants, why is it that according to WHO ma depression and anxiety make up 25% of reported cases of mental illness globally (Who. int, 2005). Specifically, with postpartum depression occurring universally with incidence rates being maintained at around 20% (Centre of Health Statistics, 2008), stress and its relationship with PPD is certainly an important topic to study. Looking at the effects PPD has on so many women such as appetite loss, weight fluctuations, insomnia, fatigue, suicidal thoughts, and feelings of worthlessness (Sadock and Sadock 2005). Having these effects in mind, when pregnancy should ideally be seen as a delightful period for women, highlights the importance of understanding and managing PPD. Although there has been research on both direct and indirect stressors on PPD, one rising stressor nowadays -rise in urban upbringing and urbanization- has not yet been studied about PPD. Hence this essay aims to explore the link between the two, but also explore management methods for women suffering from PPD. Also, the limitations of coming to conclusions about causal relationships between different stressors and PPD will be outlined.


The primary search was through Primo and Google Scholar with general search terms for example 'stressors of the 21st century' and 'postpartum depression'. When I found that urban upbringing is considered a stressor, I then searched specifically using terms such as 'urban upbringing stress and postpartum depression', which didn't have any relevant outcomes. I then found links between urban upbringing and stress, and stress and PPD to make a hypothesis for what I considered a gap in the literature. I also searched for 'factors affecting postpartum depression' to get an idea of what is already known and how research studies are carried out for PPD to explore limitations.

Urban upbringing related to PPD?

With more than 50% of the world's population now living in urban areas -cities and towns- for the first time in history, the potential impact this has on people is concerning. Although urban upbringing comes with many privileges such as more job opportunities, better hygiene, and access to healthcare there are some health risks associated with it (Pezawas et al., 2005). Research suggests that due to the challenging city environment, there is higher amygdala activity which in turn increases stress amongst the population (Pezawas et al., 2005). In a generation where the population living in cities is predicted to increase up to 69% in the next 30 years (Dye, 2008), knowing that anxiety and stress are some of the greatest effects of urbanization makes me question how it may impact women and the incidence rates of PPD. Research suggests that stress is strongly linked to increased risk of PPD occurring (Swendsen and Mazure, 2006). In addition, other findings suggest that some variables linked to PPD are similar to those linked to general depression (Bernazzani et al., 1997) and 'life stressors precede depression in over 80% of cases' (Swendsen and Mazure, 2006). Thus, a hypothesis can be made that stressors in daily life such as urban upbringing could be linked to PPD. Moreover, a woman's general stress levels could also impact the way new mothers cope with the challenges motherhood brings and change how they perceive stressful experiences (Arizmendi and Affonso, 1987). Dissatisfaction due to not having any control over events during motherhood is also a risk factor for PPD thus stress could have both direct and indirect effects on PPD. Hence, if urban upbringing is proven to increase stress, and stress can cause PPD, urbanization may pave the way for the high incidence of PPD. Living in the city, due to the increased demands women have to face nowadays such as heavy workload and stress in business settings may be the reason behind this. This hypothesis, if true, may have more apparent consequences as the population in cities rise

Another hypothesis that could be further investigated is the lower support provided by extended families, due to urban upbringing and its effects within families. Due to the fast-paced lifestyle as well as large distances in cities, nuclear families will likely be isolated from extended families and hence receive less support (Jack and Paschalis 1974). Terry et al. (1996) emphasize that when new parents are going through stressful situations, support from extended family is extremely important as they can provide both mental and physical support which decreases the chances of developing PPD. Also, isolated parents won't have the 'stress-buffering' effects provided by a supportive extended family that could help them cope with stressors (Collins et al., 1993).


Coming to causal relationships about different variables linked to PPD has many limitations. Firstly, although there is evidence indicating that living in the 21st century is stressful, that may only apply to certain aspects such as urban upbringing. Factors such as diseases of the newborn, also risk factors for PPD, aren't as apparent today as they were in the past (Hahn-Holbrook and Haselton, 2014). Consequently, although there may be a general trend suggesting a more stressful society, certain variables do not suggest that and this should be taken into consideration when coming to conclusions.

Moreover, when conducting studies, controlling all variables that could affect the development of PPD is very difficult as there are many risk factors. Some of these include not breast-feeding, undernourishment, lack of exercise (Hahn-Holbrook and Haselton, 2014), pregnancy hormones, poor family and spousal relationships, and stress regarding the newborn's upbringing (Goyal, Gay, and Lee, 2010), and certainly prior mental illness history (Swendsen and Mazure, 2006). This list is not exhaustive, thus not finding a large enough sample size with the same confounding variables means that it is hard to reliably say when there is a significant causal relationship between any variable and PPD. Some variables such as socioeconomic (SES) factors have controversial results. Goyal, Gay, and Lee (2010) suggest low SES factors are linked to PPD. Similarly, Broussard, Joseph, and Thompson (2012) claim that 'poverty-related stress accumulates and can lead to various stress responses that extend over time.' On the contrary, others suggest no relationship between PPD and social and demographic factors such as education and income (Clout and Brown, 2015). Likewise, many previous studies have not found any link between age (McMahon et al., 2011), education (Smith and Howard, 2008) and PPD. However, this result was based on a study where participants didn't have a low mean income, hence the important variable of low income was not a risk factor.

Risk factors vary between countries due to differences in traditions and lifestyle (Hahn-Holbrook and Haselton, 2014) so when carrying out studies, results should not be generalized. Undoubtedly, each person is unique and copes with stress and challenges differently, hence perception of stressful situations and the effect these have on women is subjective which is a limitation (Broussard, Joseph, and Thompson, 2012). Lastly, the frequency of stressful events as well as the timing of they occur could affect the extent to which each woman results in varying outcomes.

Managing these adverse effects

Due to the various limitations mentioned above, conducting studies and coming to causal relationships between risk factors and PPD requires numerous studies to be carried out considering many variables. However, with so many women suffering from PPD, having an understanding and managing the consequences that come with it is a priority.

Although reducing 21st-century stressors would be ideal, preparing women to face them is a more realistic approach. As stress is a major risk factor for PPD, hardiness training -hardiness referring to one's ability to cope with stress- has proven to be effective against PPD. The reason behind these results is how new mothers are trained to tackle problems and dilemmas that come their way either related to motherhood or not. They set targets and gain control over their lives while receiving support throughout their training to stay motivated. This indicates that when the root cause which is stress in this situation, is located and tackled, the quality of life of these mothers can be drastically improved (Bakhshizadeh, Shiroudi, and Khalatbari, 2013).

Moreover, educating clinicians about stressors that women could be exposed to, should enable them to know when a woman is at risk and when a referral is necessary (Liu and Tronick, 2013). This screening, both prenatally and postnatally up to one year after birth, should allow women to have a more personal relationship with healthcare professionals. Although the biological changes of pregnancy are similar amongst women, the SES factors such as housing, work, education, and income vary from woman to woman. With healthcare professionals having a more personal approach to patients, they have an insight into these factors, as well as cultural differences (Hung and Chung, 2001; Chan and Levy, 2004; Templeton et al., 2003) relationship satisfaction and fears and expectations each woman may have. Approaching each woman and her pregnancy as a unique case will provide the mother with the physical and mental support she requires going through this major phase in her life.

Raising awareness about PPD could help women understand that what they feel may not just be due to natural hormonal changes, but instead symptoms of PPD. Hence, educating the mothers themselves and society about PPD, about difficulties motherhood may have, how to tackle them, and where, when, and how to seek help is vital.

Nevertheless, 'researchers have noted that even 1 year of college reduces the poverty rate for minority women by half' (Rice, 2001) thus stress due to financial burden could be tackled via education.


Although there is a general trend suggesting an increase in stressors nowadays, risk factors differ amongst cultures and individuals. Several advancements have limited the stressors of our ancestral past while new ones arise. Further research should be done to establish whether there is a relationship – either direct or indirect – between PPD and urban upbringing, exploring the reasons around it such as lack of support from extended family. Moreover, 'multivariate models are necessary because of the large number of risk factors implicated in the onset of PPD' (Swendsen and Mazure, 2006) as well as a 'multifactorial model assessing direct and indirect effects' (Bernazzani et al., 1997). All risk factors should be taken into account when studying their effects and the current stress level of each participant should be established 'to obtain a baseline level' to understand the degree each risk factor contributes to PPD (Arizmendi and Affonso, 1987). Nonetheless, women participating in studies should be treated with respect and dignity and their information should remain confidential. Most importantly, no woman should have to go through such a tough battle with her self, therefore each woman must be provided with support throughout her pregnancy as well as postpartum. This should be the duty of all healthcare professionals involved.


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