SHARE: How to approach someone who might have perinatal depression.

You’re a partner, a family member or a good friend. You can see that the new mother is not herself and hasn’t been for some time. How do you tactfully suggest that she seek assistance from a health professional? And how do you bring this up without making things worse?

There is no one strategy but here are some options to consider. Many of these recommendations are drawn from the book Living with a Black Dog by Matthew and Ainsley Johnstone.[i]

1. Seeking advice

It is useful to consult someone with experience and knowledge of perinatal mood disorders. Why? First, it helps to have a better grasp of what you think is happening. Secondly, it can make your own thoughts clearer before you broach the subject. Thirdly, it helps you decide what you want to get out of the discussion. How you come across to the mother-to-be or the new mum is very important; ideally she’ll see you as a strong, reassuring presence and gain a clear view of what you would like to see happen and the acceptable alternatives.

Many people are concerned that to intervene is to be intrusive. If a friend was showing signs of a physical problem you would probably express concern, so raising your concern about an intimate’s mental health issue should not be viewed as crossing a line—rather, it demonstrates that you care.

2. Broaching the subject

You probably know the situations when you feel most comfortable together. Or you can create a time when you can talk together without pressure or interruption. Decide how far you want to press the subject—there’s likely to be resistance or denial at first. If it’s too difficult, now that you’ve opened up the subject, you could suggest a future time for raising your concerns again.

3. What to say and how

You can let her know what you’ve noticed and why you’re concerned. You are a familiar contact to her, but that may not make it any easier to raise a sensitive subject that’s so close to her sense of self and her competence. Paradoxically, the fact that she has lost her bearings and you have noticed may initially make her alarmed and defensive.

What she will want is your support. Try to take things at her pace and respect her point of view. Validate what she says and try not to reassure by minimising her distress. Listen attentively and resist giving advice, let alone judgement. If she has lost touch with reality, you can convey that you understand that what she is experiencing is real for her but that you see things a different way—and that consulting a professional is a step towards reducing her stress and sorting things out so that she can enjoy motherhood.

4. Deciding if an assessment is needed.

Hopefully, your gut feelings will tell you whether the woman you’re concerned about simply needs support or a break and a lightening of her load to allow her time out to recharge. If you make that judgement, review what’s happening within a week to check that she was not simply putting on a brave face and covering up a more substantial and persisting perinatal mood condition.

If assessment is warranted, consider the best first option. Any assessment should be discrete and sensitive and agreed to by the mother. Don’t ambush her. A mothercraft nurse who has been recommended by others can visit and give some pointers about feeding and settling the baby. This would be an acceptable intervention, and the nurse could then make an independent judgement about the n.eed for additional assessment. If consulting a GP, ensure you find one who’s sympathetic—perhaps, but not necessarily, a female  practitioner who has had children. Ask the receptionist to book a longer appointment and, if possible and acceptable, accompany the mother to the appointment. The doctor may see the woman by herself first and then invite you in later or, if the mother prefers, you might sit in on the whole interview. You need to be the ears: if the mother is distressed she may nor hear much of what the clinician has to say.

At the end of an assessment you will have a sense of the professional’s judgement and your instinct can be useful. Your priority is to leave with a detailed and comprehensive assessment, a diagnosis (such as depression or another, even physical, condition, or further tests to clarify), the causes of her condition and the recommended management options.

There may not be a clinical problem at all. Even if this is the case, the discomfort and worry you felt is most likely resolved through talking with someone like a counsellor skilled in the area who has seen it all before.

5. Why not just wait it out?

Waiting out a woman’s distress during the perinatal time is never the best option. Untreated depression or anxiety is distressing to the woman, disruptive to the family’s wellbeing and, while it persists, can compromise the mother–child bond.

This post is an except from Overcoming Baby Blues. Overcoming Baby Blues sheds light on this important medical issue via first-person accounts by mothers experiencing depression and other mood problems during pregnancy and their baby’s first year.

To unpack the problems these women face, Parker, Eyers and Boyce introduce research-based guidelines for assessing disturbed moods; explaining causes of perinatal depression; and outlining effective management strategies, including diet and lifestyle suggestions and information for partners.

If this post brings up issues for you, you can also visit Beyondblue: the national depression initiative  online, or call them on 1300 22 4636. You should also talk to your local GP or maternal health professional.