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Anger coexists with postnatal depression

An integrative review published in Birth revealed that anger coexists with postpartum mood disturbances in women.

The results also showed that anger occurs when women’s expectations about motherhood are different from reality, and when they feel trapped in situations such as poverty and intimate partner violence.

"We know that mothers can be depressed and anxious in the postpartum period, but researchers haven't really paid attention to anger," Christine H. Ou, RN, MSN, from the School of Nursing, University of British Columbia, Canada, said in a press release. "There's some evidence that indicates that being both angry and depressed worsens the intensity and length of depression. That can have many negative effects on the mother, child and family, and on the relationship between parents."

Ou and Wendy A. Hall RN, PhD, also from University of British Columbia, conducted an integrative review to study the expression of maternal anger in the context of postnatal depression. The investigators searched four clinical databases for relevant literature within a 25-year period — 1991 to September 2016 — and identified seven qualitative and 17 quantitative papers examining maternal anger and postnatal depression.

After evaluating the 24 studies that examined anger and its connection with postnatal depression, the authors identified three themes:

• anger accompanies mood disturbance during the postnatal period;

• ties between anger, depression and feeling powerless in relationships and life situations; and

• anger was linked to discordance between reality and expectations.

In their review, Ou and Hall found that social determinants of health, such as poverty and younger age, added to women’s anger and depression. Financial difficulty seemed to undermine women’s sense of power. Feeling powerless also included situations of abuse and violence in relationships, according to the findings.

The literature showed that many depressed mothers in the included studies included were lacking in support from the network of people, including their significant other, who they expected to provide support. Stressors, such as family illness and deaths, moving, marital breakdown and money problems, combined with a lack of support, also heightened mothers’ feelings of anger and depression. In addition, concern about loss of mothers’ pre-birth selves was tied to anger and depression.

"Anger can be a reaction to broken expectations about what mothering will be like," Ou said in the press release. "Mothers may feel that they have not met their own expectations and that also others may judge them because, for example, they're formula-feeding instead of breastfeeding. Many mothers have also expressed feeling let down by others in terms of support from partners, family members, and health-care providers as well."

Anger was also found to be linked to recurrent and chronic depression. The results showed that mothers with episodes of depression before childbirth or recurring depressive episodes after postnatal depression were more likely to report anger than those who only reported postnatal depression.

“Longitudinal studies are needed to determine mothers’ and children’s outcomes associated with anger as a mood disturbance alone compared with comorbid anger and depressive symptoms,” Ou and Hall wrote. “Although there is no well-defined answer as to how anger should be framed in the context of postnatal depression, we propose that while anger and depression can be considered distinct constructs, they occur concurrently for some women.” – by Savannah Demko

Disclosure: Healio Psychaitry was unable to confirm any relevant financial disclosures at the time of publication.