Risk for depression, anxiety after stillbirth higher with lack of paternal support
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A perceived lack of paternal support following a stillbirth increased mothers’ odds of developing depression or anxiety, according to a study published in JAMA Network Open.
“At the height of the COVID pandemic, our hospital’s visitation policy prevented partners from attending in-person prenatal visits or obstetric ultrasounds,” Adam K. Lewkowitz, MD, MPHS, an assistant professor in the division of maternal-fetal medicine at Brown University in Providence, Rhode Island, told Healio. “Viewing patients alone in their examination room or ultrasound suites was a clear metaphor for how I — and other prenatal care providers — have historically perceived our birthing patients: completely in isolation, without considering the extent to which partner or family dynamics may affect their perinatal experience or their mood.”
Lewkowitz and colleagues used data from the Stillbirth Collaborative Research Network — a case-controlled study conducted in 59 hospitals from 2006 to 2009 — to determine whether participants’ perception of their partners’ support influenced the development of postpartum depression or anxiety (PPDA) 6 to 36 months after experiencing a stillbirth.
Likelihood of PPDA
In total, 269 women responded to questions about paternal support during follow-up, 238 (88.5%) of whom indicated they received support from their partner.
PPDA occurred in 49.8% of participants. However, those who reported not receiving paternal support had significantly greater odds of experiencing PPDA compared with those who did receive support (80.6% vs. 45.8%; adjusted OR = 4.67; 95% CI, 2.73-8). Women who reported not receiving paternal support were also more likely to have postpartum depression only (aOR = 2.23; 95% CI, 1.46-3.41) and anxiety only (aOR = 2.73; 95% CI, 1.75-4.26).
“What was surprising was that, when we compared the risk of developing postpartum depression or anxiety after stillbirth for those who did not perceive paternal support to that of known risk factors, lacking partner support was the strongest risk factor among all we analyzed including prior history of depression or anxiety, which is generally considered to be the most important risk factor for postpartum depression/anxiety,” Lewkowitz said.
Providing support
While each situation is different, Lewkowitz emphasized the importance of partners taking steps to prepare themselves to support their pregnant partner. During his wife’s first pregnancy, Lewkowitz said that his “wife insisted that [he] attend all parenting education classes that she did.
“My wife had an unanticipated cesarean birth, and had I not had hours of hands-on instruction at these classes, I could say with 100% certainty that I would not have been properly equipped to support my wife by taking the lead on infant care and helping her learn to breastfeed, all while she recovered from major surgery,” he said. “I always share my personal experience as a new father with non-birthing partners as a way to encourage them to sign up for these classes.
“On a more global level, I do think we as obstetricians must do a better job of engaging with non-birthing partners during prenatal care visits to provide joint support and education in preparation for a smoother postpartum transition,” Lewkowitz added.
Moving forward, clinicians should assess patients’ perceptions of partner support following a stillbirth in addition to typical mental health counseling following a stillbirth, Lewkowitz said.