post dissertation depression

Managing While and Post-PhD Depression And Anxiety: PhD Student Survival Guide

Embarking on a PhD journey can be as challenging mentally as it is academically. With rising concerns about depression among PhD students, it’s essential to proactively address this issue. How to you manage, and combat depression during and after your PhD journey?

In this post, we explore the practical strategies to combat depression while pursuing doctoral studies.

From engaging in enriching activities outside academia to finding supportive networks, we describe a variety of approaches to help maintain mental well-being, ensuring that the journey towards academic excellence doesn’t come at the cost of your mental health.

How To Manage While and Post-Phd Depression

Why phd students are more likely to experience depression than other students.

The journey of a PhD student is often romanticised as one of intellectual rigour and eventual triumph.

However, beneath this veneer lies a stark reality: PhD students are notably more susceptible to experiencing depression and anxiety.

This can be unfortunately, quite normal in many PhD students’ journey, for several reasons:

Grinding Away, Alone

Imagine being a graduate student, where your day-to-day life is deeply entrenched in research activities. The pressure to consistently produce results and maintain productivity can be overwhelming. 

For many, this translates into long hours of isolation, chipping away at one’s sense of wellbeing. The lack of social support, coupled with the solitary nature of research, often leads to feelings of isolation.

Mentors Not Helping Much

The relationship with a mentor can significantly affect depression levels among doctoral researchers. An overly critical mentor or one lacking in supportive guidance can exacerbate feelings of imposter syndrome.

Students often find themselves questioning their capabilities, feeling like they don’t belong in their research areas despite their achievements.

Nature Of Research Itself

Another critical factor is the nature of the research itself. Students in life sciences, for example, may deal with additional stressors unique to their field.

Specific aspects of research, such as the unpredictability of experiments or the ethical dilemmas inherent in some studies, can further contribute to anxiety and depression among PhD students.

Competition Within Grad School

Grad school’s competitive environment also plays a role. PhD students are constantly comparing their progress with peers, which can lead to a mental health crisis if they perceive themselves as falling behind.

This sense of constant competition, coupled with the fear of failure and the stigma around mental health, makes many hesitant to seek help for anxiety or depression.

How To Know If You Are Suffering From Depression While Studying PhD?

If there is one thing about depression, you often do not realise it creeping in. The unique pressures of grad school can subtly transform normal stress into something more insidious.

As a PhD student in academia, you’re often expected to maintain high productivity and engage deeply in your research activities. However, this intense focus can lead to isolation, a key factor contributing to depression and anxiety among doctoral students.

Changes in Emotional And Mental State

You might start noticing changes in your emotional and mental state. Feelings of imposter syndrome, where you constantly doubt your abilities despite evident successes, become frequent.

This is especially true in competitive environments like the Ivy League universities, where the bar is set high. These feelings are often exacerbated by the lack of positive reinforcement from mentors, making you feel like you don’t quite belong, no matter how hard you work.

Lack Of Pleasure From Previously Enjoyable Activities

In doctoral programs, the stressor of overwork is common, but when it leads to a consistent lack of interest or pleasure in activities you once enjoyed, it’s a red flag. This decline in enjoyment extends beyond one’s research and can pervade all aspects of life.

The high rates of depression among PhD students are alarming, yet many continue to suffer in silence, afraid to ask for help or reveal their depression due to the stigma associated with mental health issues in academia.

Losing Social Connections

Another sign is the deterioration of social connections. Graduate student mental health is significantly affected by social support and isolation.

You may find yourself withdrawing from friends and activities, preferring the solitude that ironically feeds into your sense of isolation.

Changes In Appetite And Weight

Changes in appetite and weight can be a significant indicator of depression. As they navigate the demanding PhD study, students might experience fluctuations in their eating habits.

Some may find themselves overeating as a coping mechanism, leading to weight gain. Others might lose their appetite altogether, resulting in noticeable weight loss.

These changes are not just about food; they reflect deeper emotional and mental states.

Such shifts in appetite and weight, especially if sudden or severe, warrant attention as they may signal underlying depression, a common issue in the high-stress environment of PhD studies.

Unhealthy Coping Mechanisms

PhD students grappling with depression often feel immense pressure to excel academically while battling isolation and imposter syndrome. Lacking adequate mental health support, some turn to unhealthy coping mechanisms like substance abuse. These may include:

• Overeating, 
• And many more.

These provide temporary relief from overwhelming stress and emotional turmoil. However, such methods can exacerbate their mental health issues, creating a vicious cycle of dependency and further detachment from healthier coping strategies and support systems.

It’s essential for PhD students experiencing depression to recognise these signs and seek professional help. Resources like the National Suicide Prevention Lifeline are very helpful in this regard.

Suicidal Thoughts Or Attempts

Suicidal thoughts or attempts may sound extreme, but they can happen in PhD studies. This is because of the high-pressure environment of PhD studies.

Doctoral students, often grappling with intense academic demands, social isolation, and imposter syndrome, can be susceptible to severe mental health crises.

When the burden becomes unbearable, some may experience thoughts of self-harm or suicide as a way to escape their distress. These thoughts are a stark indicator of deep psychological distress and should never be ignored.

It’s crucial for academic institutions and support networks to provide robust mental health resources and create an environment where students feel safe to seek help and discuss their struggles openly.

How To Prevent From Depression During And After Ph.D?

A PhD student’s experience is often marked by high rates of depression, a concern echoed in studies from universities like the University of California and Arizona State University. If you are embarking on a PhD journey, make sure you are aware of the issue, and develop strategies to cope with the stress, so you do not end up with depression. 

Engage With Activities Outside Academia

One effective strategy is engaging in activities outside academia. Diverse interests serve as a lifeline, breaking the monotony and stress of grad school. Some activities you can consider include:

• Social gatherings.

These activities provide a crucial balance. For instance, some students highlighted the positive impact of adopting a pet, which not only offered companionship but also a reason to step outside and engage with the world.

Seek A Supportive Mentor

The role of a supportive mentor cannot be overstated. A mentor who adopts a ‘yes and’ approach rather than being overly critical can significantly boost a doctoral researcher’s morale.

This positive reinforcement fosters a healthier research environment, essential for good mental health.

Stay Active Physically

Physical exercise is another key element. Regular exercise has been shown to help cope with symptoms of moderate to severe depression. It’s a natural stress reliever, improving mood and enhancing overall wellbeing. Any physical workout can work here, including:

• Brisk walking
• Swimming, or
• Gym sessions.

Seek Positive Environment

Importantly, the graduate program environment plays a critical role. Creating a community where students feel comfortable to reveal their depression or seek help is vital.

Whether it’s through formal support groups or informal peer networks, building a sense of belonging and understanding can mitigate feelings of isolation and imposter syndrome.

This may be important, especially in the earlier stage when you look and apply to universities study PhD . When possible, talk to past students and see how are the environment, and how supportive the university is.

Choose the right university with the right support ensures you keep depression at bay, and graduate on time too.

Remember You Have The Power

Lastly, acknowledging the power of choice is empowering. Understanding that continuing with a PhD is a choice, not an obligation. If things become too bad, there is always an option to seek a deferment, pause. You can also quit your studies too.

Work on fixing your mental state, and recover from depression first, before deciding again if you want to take on Ph.D studies again. There is no point continuing to push yourself, only to expose yourself to self-harm, and even suicide.

Wrapping Up: PhD Does Not Need To Ruin You

Combating depression during PhD studies requires a holistic approach. Engaging in diverse activities, seeking supportive mentors, staying physically active, choosing positive environments, and recognising one’s power to make choices are all crucial.

These strategies collectively contribute to a healthier mental state, reducing the risk of depression. Remember, prioritising your mental well-being is just as important as academic success. This helps to ensure you having a more fulfilling and sustainable journey through your PhD studies.

Dr Andrew Stapleton has a Masters and PhD in Chemistry from the UK and Australia. He has many years of research experience and has worked as a Postdoctoral Fellow and Associate at a number of Universities. Although having secured funding for his own research, he left academia to help others with his YouTube channel all about the inner workings of academia and how to make it work for you.

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• Postpartum depression

The birth of a baby can start a variety of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Most new moms experience postpartum "baby blues" after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues usually begin within the first 2 to 3 days after delivery and may last for up to two weeks.

But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Sometimes it's called peripartum depression because it can start during pregnancy and continue after childbirth. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression is not a character flaw or a weakness. Sometimes it's simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms and help you bond with your baby.

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Symptoms of depression after childbirth vary, and they can range from mild to severe.

Baby blues symptoms

Symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:

• Mood swings
• Irritability
• Feeling overwhelmed
• Reduced concentration
• Appetite problems
• Trouble sleeping

Postpartum depression symptoms

Postpartum depression may be mistaken for baby blues at first — but the symptoms are more intense and last longer. These may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth. But they may begin earlier — during pregnancy — or later — up to a year after birth.

Postpartum depression symptoms may include:

• Depressed mood or severe mood swings
• Crying too much
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep, called insomnia, or sleeping too much
• Overwhelming tiredness or loss of energy
• Less interest and pleasure in activities you used to enjoy
• Intense irritability and anger
• Fear that you're not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt or inadequacy
• Reduced ability to think clearly, concentrate or make decisions
• Restlessness
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Recurring thoughts of death or suicide

Untreated, postpartum depression may last for many months or longer.

Postpartum psychosis

With postpartum psychosis — a rare condition that usually develops within the first week after delivery — the symptoms are severe. Symptoms may include:

• Feeling confused and lost
• Having obsessive thoughts about your baby
• Hallucinating and having delusions
• Having sleep problems
• Having too much energy and feeling upset
• Feeling paranoid
• Making attempts to harm yourself or your baby

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

Postpartum depression in the other parent

Studies show that new fathers can experience postpartum depression, too. They may feel sad, tired, overwhelmed, anxious, or have changes in their usual eating and sleeping patterns. These are the same symptoms that mothers with postpartum depression experience.

Fathers who are young, have a history of depression, experience relationship problems or are struggling financially are most at risk of postpartum depression. Postpartum depression in fathers — sometimes called paternal postpartum depression — can have the same negative effect on partner relationships and child development as postpartum depression in mothers can.

If you're a partner of a new mother and are having symptoms of depression or anxiety during your partner's pregnancy or after your child's birth, talk to your health care provider. Similar treatments and supports provided to mothers with postpartum depression can help treat postpartum depression in the other parent.

When to see a doctor

If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But if you experience any symptoms of postpartum baby blues or postpartum depression, call your primary health care provider or your obstetrician or gynecologist and schedule an appointment. If you have symptoms that suggest you may have postpartum psychosis, get help immediately.

It's important to call your provider as soon as possible if the symptoms of depression have any of these features:

• Don't fade after two weeks.
• Are getting worse.
• Make it hard for you to care for your baby.
• Make it hard to complete everyday tasks.
• Include thoughts of harming yourself or your baby.

If you have suicidal thoughts

If at any point you have thoughts of harming yourself or your baby, immediately seek help from your partner or loved ones in taking care of your baby. Call 911 or your local emergency assistance number to get help.

Also consider these options if you're having suicidal thoughts:

• Seek help from a health care provider.
• Call a mental health provider.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Helping a friend or loved one

People with depression may not recognize or admit that they're depressed. They may not be aware of signs and symptoms of depression. If you suspect that a friend or loved one has postpartum depression or is developing postpartum psychosis, help them seek medical attention immediately. Don't wait and hope for improvement.

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There is no single cause of postpartum depression, but genetics, physical changes and emotional issues may play a role.

• Genetics. Studies show that having a family history of postpartum depression — especially if it was major — increases the risk of experiencing postpartum depression.
• Physical changes. After childbirth, a dramatic drop in the hormones estrogen and progesterone in your body may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed.
• Emotional issues. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive, struggle with your sense of identity or feel that you've lost control over your life. Any of these issues can contribute to postpartum depression.

Risk factors

Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if:

• You have a history of depression, either during pregnancy or at other times.
• You have bipolar disorder.
• You had postpartum depression after a previous pregnancy.
• You have family members who've had depression or other mood disorders.
• You've experienced stressful events during the past year, such as pregnancy complications, illness or job loss.
• Your baby has health problems or other special needs.
• You have twins, triplets or other multiple births.
• You have difficulty breastfeeding.
• You're having problems in your relationship with your spouse or partner.
• You have a weak support system.
• You have financial problems.
• The pregnancy was unplanned or unwanted.

Complications

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.

• For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming an ongoing depressive disorder. Mothers may stop breastfeeding, have problems bonding with and caring for their infants, and be at increased risk of suicide. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression.
• For the other parent. Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby's other parent may also increase. And these other parents may already have an increased risk of depression, whether or not their partner is affected.
• For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, crying too much, and delays in language development.

If you have a history of depression — especially postpartum depression — tell your health care provider if you're planning on becoming pregnant or as soon as you find out you're pregnant.

• During pregnancy, your provider can monitor you closely for symptoms of depression. You may complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy.
• After your baby is born, your provider may recommend an early postpartum checkup to screen for symptoms of postpartum depression. The earlier it's found, the earlier treatment can begin. If you have a history of postpartum depression, your provider may recommend antidepressant treatment or talk therapy immediately after delivery. Most antidepressants are safe to take while breastfeeding.
• Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision DSM-5-TR. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed May 9, 2022.
• Postpartum depression. Office on Women's Health. https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression. Accessed May 5, 2022.
• Depression among women. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/depression/index.htm. Accessed May 5, 2022.
• What is peripartum depression (formerly postpartum)? American Psychiatric Association. https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression. Accessed Nov. 18, 2022.
• Viguera A. Postpartum unipolar depression: Epidemiology, clinical features, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed Nov. 18, 2022.
• Viguera A. Mild to moderate postpartum unipolar major depression: Treatment. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
• Viguera A. Severe postpartum unipolar major depression: Choosing treatment. https://www.uptodate.com/contents/search. Accessed May 6, 2022.
• Faden J, et al. Intravenous brexanolone for postpartum depression: What it is, how well does it work, and will it be used? Therapeutic Advances in Psychopharmacology. 2020; doi:10.1177/2045125320968658.
• FAQs. Postpartum depression. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/postpartum-depression. Accessed May 6, 2022.
• Suicide prevention. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/suicide-prevention. Accessed May 6, 2022.
• Postpartum depression. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/postpartum-care-and-associated-disorders/postpartum-depression#. Accessed May 6, 2022.
• AskMayoExpert. Depression in pregnancy and postpartum. Mayo Clinic; 2022.
• American Academy of Pediatrics. Postpartum care of the mother. In: Guidelines for Perinatal Care. 8th ed. American Academy of Pediatrics; American College of Obstetricians and Gynecologists; 2017.
• Kumar SV, et al. Promoting postpartum mental health in fathers: Recommendations for nurse practitioners. American Journal of Men's Health. 2018; doi:10.1177/1557988317744712.
• Scarff JR. Postpartum depression in men. Innovations in Clinical Neuroscience. 2019;16:11.
• Bergink V, et al. Postpartum psychosis: Madness, mania, and melancholia in motherhood. American Journal of Psychiatry. 2016; doi:10.1176/appi.ajp.2016.16040454.
• Yogman M, et al. Fathers' roles in the care and development of their children: The role of pediatricians. Pediatrics. 2016; doi:10.1542/peds.2016-1128.
• FDA approves first treatment for post-partum depression. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression. Accessed May 6, 2022.
• Deligiannidis KM, et al. Effect of zuranolone vs placebo in postpartum depression: A randomized clinical trial. JAMA Psychiatry. 2021; doi:10.1001/jamapsychiatry.2021.1559.
• Betcher KM (expert opinion). Mayo Clinic. May 10, 2022.
• 988 Suicide & Crisis Lifeline. https://988lifeline.org/. Accessed Nov. 18, 2022.

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• Surviving the Post-Dissertation Slump The article offers the author's insights on the survival of the post-dissertation stress disorder and post dissertation depression during acedemic studies.
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Postpartum depression risk factors: A narrative review

Maryam ghaedrahmati.

Reproductive Health Department Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Ashraf Kazemi

1 Women's Health Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Gholamreza Kheirabadi

2 Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Amrollah Ebrahimi

Masood bahrami.

3 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Postpartum depression is a debilitating mental disorder with a high prevalence. The aim of this study was review of the related studies. In this narrative review, we report studies that investigated risk factors of postpartum depression by searching the database, Scopus, PubMed, ScienceDirect, Uptodate, Proquest in the period 2000-2015 published articles about the factors associated with postpartum depression were assessed in Farsi and English. The search strategy included a combination of keywords include postpartum depression and risk factors or obstetrical history, social factors, or biological factors. Literature review showed that risk factors for postpartum depression in the area of economic and social factors, obstetrical history, and biological factors, lifestyle and history of mental illness detected. Data from this study can use for designing a screening tools for high-risk pregnant women and for designing a prevention programs.

Introduction

Postpartum depression is a debilitating mental disorder with a prevalence between 5% and 60.8% worldwide.[ 1 ] The intensity of feeling inability in suffering mothers is so high that some mothers with postpartum depression comment life as the death swamp[ 2 ] while nondepressed mothers see their baby's birth as the happiest stage of their life.[ 3 ] The disease manifests as sleep disorders, mood swings, changes in appetite, fear of injury, serious concerns about the baby, much sadness and crying, sense of doubt, difficulty in concentrating, lack of interest in daily activities, thoughts of death and suicide.[ 4 , 5 ] Feelings of hopelessness in severe cases of illness can threaten life and lead to suicide;[ 6 ] it is a factor that causes 20% of maternal deaths in the course after giving birth.[ 7 ] In addition, issues such as fear of harming the baby (36%), weak attachment to the baby (34%) and even, in extreme cases, child suicide attempts have been reported.[ 8 , 9 ] These symptoms have serious effects on family health.[ 10 ] Therefore, susceptible people need to be identified before delivery to receive proper care measures. However, the development of screening programs as well as designing evidence-based prevention programs requires principled collection of scientific documentations. However, systematic reviews were seen in the review of some available studies that have assessed the resources in explaining the therapeutic effects of selective serotonin reuptake inhibitors on postpartum depression[ 11 ] and cognitive behavioral therapies.[ 12 ] Review studies seem to be inadequate, which evaluate the social factors besides addressing biological and psychological factors, while for achieving sufficient knowledge to design screening and preventing programs, all the factors associated with postpartum depression need be evaluated together. Thus, this study aimed to evaluate risk factors for postpartum depression during pregnancy and afterward.

Materials and Methods

This was a review (narrative) study, in which literature in English and Farsi was evaluated using electronic search in databases of Scopus, PubMed, ScienceDirect, UpToDate, and Proquest in the time range returns between 2000 and 2015. Searching in the databases was made using key words of “postpartum depression” and “risk factors” or “predisposing factors” or “predictive factors” and “biological agents” or “social factors” or “pathophysiology” or “hormonal factors” or “lifestyle” and “pregnancy.” In assessing in the PubMed database, the keywords were selected in accordance with the MeSH system. Those articles were included in the study that had done research on risk factors and predisposing factors of postpartum depression, which were of cross-sectional, cohort, case–control, interventional, and review article types. In addition, the illness diagnosis basis in these articles was the diagnosis of depression within 4 weeks after giving birth to 1 year after delivery. The articles improper regarding the adequacy of sample size, research design, and statistical methods were excluded from the study.

In the initial evaluation of the articles titles, 200 paper abstracts were extracted and evaluated by two members of the research team in terms of inclusion criteria after removal the authors’ names. In case of nonagreement on the presence if inclusion criteria between the two evaluators, the articles abstract was given to the third evaluator whose opinion was determinant to include the article in the review. According to the articles arbitration, 74 papers were detected appropriate. Then, the full-texts of available articles were prepared. In case of articles with unavailable full text, correspondence was done with the authors to request them for sending the article's full text after explaining the purpose of the survey.

The articles were evaluated by three team members of the research in terms of inclusion criteria. In case of meeting the inclusion criteria, the article was reviewed and contents related to the subject were extracted. Thus, the main results of each study with the article's specifications under the relevant title were noted. After collecting, the material and content were categorized based on scientific content in their respective area subsets.

Results and Discussion

Articles’ assessment showed that the factors associated with postpartum depression can be classified in five domains of risk factors for psychiatric, obstetric risk factors, biological and hormonal risk factors, social risk factors, and lifestyle risk factors.

Psychological factors

Previous history of depression and anxiety is among the factors that are associated with a higher risk of postpartum depression. The relationship between postpartum depression and prior onset of depression has been reported in many studies,[ 13 , 14 ] which has been referred to as powerful factors in postpartum depression.[ 15 , 16 ] The occurrence of mental health disorders such as depression during pregnancy is a powerful factor in predicting postpartum depression.[ 17 ]

There is evidence in explaining these relationships suggesting that women with a positive history of depression are more susceptible to hormonal changes.[ 18 ] In support of this finding, it has reported that a history of moderate to severe premenstrual syndrome (PMS) is a factors affecting the onset of postpartum depression.[ 19 ] In women with severe PMS, the serotonin transport system will change while the serotonin transporter polymorphism area is associated with major depression.[ 20 ] High serotonin polymorphism may lead to tryptophan depletion and induction of postpartum major depression.[ 21 ]

In addition to previous depression history, negative attitude toward the recent pregnancy, number of life events,[ 18 ] and a history of sexual abuse in the past[ 22 ] were as predisposing risk factors of postpartum depression. Furthermore, the reluctance of the baby gender[ 13 ] and having low self-esteem with the impact on parenting stress[ 22 ] are factors that contribute in the development of postpartum depression.

Obstetric risk factors

Assessment the relationship between the number of delivery and postpartum depression has been associated with conflicting results. Mayberry et al . have reported postpartum depression is more prevalent in multiparous women than in nulliparous women[ 23 ] while the results of another study indicate a higher prevalence of the disease in nulliparous women.[ 16 ] Furthermore, in a study conducted by Matsin in 2013, on 86 participants within 6 weeks after delivery, it was found that having two or more children due to higher psychological burden is more likely to be associated with the occurrence of depression.[ 10 ] The discrepancies between the results of these studies suggest that the number of childbirth alone is not an independent factor for developing postpartum depression and the development of pathological conditions for the occurrence of the illness is caused by psychosocial conditions that the multiplicity of delivery creates for the women.

Risky pregnancy is also associated with an increased risk of postpartum depression. These risks include conditions that lead to performing emergency cesarean section or hospitalization during pregnancy. Postpartum complications[ 22 , 24 ] are also effective on the incidence of postpartum depression as much as during labor complications such as meconium passage, umbilical cord prolapse, and obstetric hemorrhages.[ 10 ] Mothers with the birth of an infant with a weight <1500 g are 4–18 times at risk for postpartum depression[ 25 ] more than others.

A mismatch between the expectations of mother and pregnancy events is as factors that affect the occurrence of depression. It has been reported that women with strong desire to have natural childbirth during the perinatal period whose delivery are done by caesarean section are more prone to risk for postpartum depression than others.[ 26 ] Spending the course of pregnancy in a natural state away from the excitements due to complications during pregnancy and preparedness for the delivery seem to be as conditions effective in the prevention of postpartum depression. Since it has been reported that the use of epidural anesthesia during childbirth, attending in childbirth preparation classes during pregnancy, and continued breastfeeding after childbirth were associated with a reduced risk of postpartum depression.[ 27 ] However, insomnia during pregnancy can lead to the risk of recurrent postpartum depression in women with a previous history of the disease.[ 28 ]

The inverse association between breastfeeding and postpartum depression shows that breastfeeding is associated with a reduction in the rate of postpartum depression. It has been reported that women exclusively breastfeed their infants in the first 3 months after childbirth show lower values of Edinburgh Postnatal Depression Scale.[ 29 ] In a study conducted by Hamdan and Tamim, it was found that breastfeeding during the first 4 months after delivery reduces the risk of postpartum depression.[ 30 ] Although no causal relationship has been established for the relationship between breastfeeding and postpartum depression, breastfeeding increases the interaction between mother and baby[ 31 , 32 ] and thereby may affect the health of the mother.

A relationship has been observed between low hemoglobin concentration at day 7 after delivery (<120 g/L) and postpartum depressive symptoms at day 28 after childbirth.[ 3 ] Furthermore, an effective correlation has been seen between homocysteinemia in the 1 st week and 6 weeks after delivery and depression. However, there is not enough evidence in this regard that postpartum anemia can cause postpartum depression or complications of pregnancy period associated with the postpartum anemia may lead to increased risk of the disease.

Biological factors

Young age during pregnancy increases the risk of depression. The highest level of depression has been reported in mothers aged 13–19 years[ 33 ] while the lowest rate has been seen in women with the age range of 31–35-year-old.[ 34 ] In a study conducted by Abdollahi et al . on 1950 women at 2–12 weeks after giving birth, it was found that increasing maternal age and maternal self-efficacy are associated with a reduced risk of postpartum depression.[ 35 ]

Studies show that glucose metabolism disorders during pregnancy are also as predisposing factors for postpartum depression so that it has been observed that women with higher blood glucose levels (mean of 120 vs. 114 mg/dl) after an hour after performing the glucose challenge test with 50 g of glucose were more at risk of postpartum depression than others.[ 36 ]

Serotonin and tryptophan levels in the blood are also known factors effective on depression. A study has shown a relationship between different serotonin transporter gene alleles and serotonin receptors with mood disorders and depression.[ 37 ] Serotonin is a monoamine neurotransmitter that is synthesized during an enzymatic route from amino acid tryptophan.[ 38 ] The amount of serotonin directly depends on the individual diet. The consumption of foods rich in protein reduces the amounts of tryptophan and serotonin in the brain while a carbohydrate snack has reverse effects.[ 38 ] In nutritional deficiencies, reduced brain tryptophan (a precursor of serotonin) up to 15% leads to increased depression scale rate of postpartum depression.[ 21 ]

Oxytocin also plays a key role in regulating emotions, social interactions, and emotional responses.[ 39 ] Higher levels of oxytocin in midpregnancy have been predictors of postpartum depression within less than the first 2 weeks after delivery.[ 40 ] Recent evidence suggests that oxytocin induces the activity of serotonin receptors[ 41 ] and reduces the response to stress. The intranasal oxytocin spraying has increased the duration of positive behaviors such as eye contact and possibility of emotions and feelings both in women and men.[ 42 ]

The role of estrogen has been also evaluated in the incidence of postpartum depression. Studies on animal models have shown that steroid and estrogen hormones are modulators of transcription from nervous neurotransmitters[ 43 ] and adjust the function of serotonin receptors.[ 44 ] This hormone causes the renewal of the generation of damaged neurons in brain and leads to the production of brain neurotransmitters.[ 45 ] In hypothalamus, estrogen also affects the neurotransmitters and regulates sleep and temperature. It has been observed that the fluctuations in this hormone or its absence is associated with depression.[ 45 ]

The role of corticotropin-releasing hormone in the regulation of steroid hormones and depression has been studied as well. In addition to hypothalamus, this hormone is also produced during pregnancy in placenta, uterus, and ovaries and regulates the pituitary-hypothalamus-adrenal axis for production of steroid hormones.[ 46 ] After delivery and expulsion of the placenta, dramatic drop of this hormone leads to reduced production of steroid hormones such as estrogen and leads to increased susceptibility to depression in the first 12 weeks after childbirth.[ 47 ] In addition to steroid hormones, some evidence has been reported suggesting the inverse association of free thyroxine levels and total serum thyroxine concentrations with symptoms of postpartum depression.[ 48 ]

Although the relationship between thyroid dysfunction and postpartum depression has not been certainly established, the disorder may cause postpartum depression in a subgroup of women.[ 18 ] According to a report, a positive thyroid peroxidase antibody test at 32 weeks of pregnancy will increase the risk of postpartum depression as 2–3 times.[ 49 ]

In addition to the association of some endogenous hormones with postpartum depression, cytokine network and inflammatory responses have been observed to be involved in the pathophysiology of depression as well.[ 50 ] Administration of cytokines such as interferon alpha and cytokine inducers such as lipopolysaccharides and typhoid vaccines have caused behavioral changes such as mood disorders, anorexia, fatigue, sleep disorders, and other temperamental mood swings, which overlap with depression symptoms.[ 51 ] Depressed women may develop postpartum psychoneuroimmunological disorder, which is caused by inflammatory response turmoil in the normal course of labor and delivery.[ 52 ] Some evidence of changes in the regulators of T-cells has also been observed in depressed women before delivery.[ 53 ] The mechanism of explaining the changes in T-cells in depression is unknown. However, it is observed that the T-cells develop apoptosis in depressed patients. One of the possible mechanisms of explaining T-cells apoptosis in depression is the increased activity of the immune system, especially depletion of their tryptophan. Tryptophan is an essential component for the proliferation of T-cells, and in an environment free of tryptophan, the T-cells undergo apoptosis process.[ 51 ]

In depressed patients, increased apoptosis in the T-cells along with decreased response to glucocorticoids will lead to decreased available T-cells and reduced the capacity of the brain in response to immunological stimuli.[ 51 ]

Social factors

Social support refers to emotional support, financial support, intelligence support, and empathy relations.[ 54 ] The role of social support in reducing postpartum depression has been demonstrated.[ 55 ] Reducing social support is the most important environmental factor in the onset of depression and anxiety disorders.[ 56 ] At the International Conference on Population and Development of the year, decision-making power at home and increased support of the partner have been considered as the most important solution to promote women's reproductive health.[ 57 ] The spouse sexual violence and other forms of domestic violence during pregnancy are seen as factors contributing to the incidence of postpartum depression.[ 58 ]

In addition to the women's relationship with family members and community, behaviors such as smoking during prenatal period, is of social factors associated with increased incidence of postpartum depression as 1.7 times.[ 59 ]

The simultaneous relationship between smoking and socioeconomic level and the relationship between socioeconomic level with depression complicate the association between smoking and postpartum depression. However, the physiological changes of pregnancy may seem as a stressful event for some mothers and lead to the onset of depression symptoms and start of smoking.[ 60 ]

Another social factor is employment status, especially professional careers, which have been associated with a reduced risk of postpartum depression.[ 61 ] However, education and low income are associated with the risk of postpartum depression.[ 36 , 62 ]

Among the factors related to lifestyle, factors of food intake patterns, sleep status, exercise, and physical activities may affect postpartum depression. It was observed that sufficient consumption of vegetables, fruits, legumes, seafood, milk and dairy products, olive oil, and a variety of nutritious may reduce postpartum depression as 50%.[ 63 ]

Vitamin B6 is effective in the production of serotonin from tryptophan as a cofactor. Therefore, the reduction of this vitamin may be involved in the process of postpartum depression.[ 64 ] In a study, the positive relation between the level of vitamin B2 absorption at week 21 of pregnancy and postpartum depression has been reported.[ 37 ] The results of an ecological study from 23 countries found that increased seafood consumption is associated with reduced risk of postpartum depression.

The results of an ecological study on 23 countries indicated that high docosahexaenoic acid levels and increased seafood consumption have been associated with reduced risk of postpartum depression.[ 65 , 66 ] This compound is found in fish oil.

Among the micronutrients, reduced intake of zinc and selenium is linked with the incidence of postpartum depression.[ 67 ] It was reported in a study that zinc applies its antidepressant by influencing the serotonin reuptake.[ 68 ] Selenium deficiency is likely to affect the postpartum depression by developing thyroid dysfunction.[ 69 ] Zinc is specifically found in red meat, grains, meat, and fish.

In addition to nutritional status, sleep status is among the factors influencing the risk of depression. Evidence shows that there is a relationship between less sleep and postpartum depression.[ 20 , 70 ] Furthermore, an effective relationship has been observed between the rate of fatigue and depression levels in days after delivery. Periods of severe sleep deprivation have been reported in depressed women after delivery.[ 20 ] Chronic sleep deprivation affects glucose metabolism, inflammatory processes, social communications, mental health, and the quality of life.[ 71 ] In addition, acute episodes of sleep deprivation affect the immune system and increase inflammatory markers such as interleukin-6 and tumor necrosis factor while these inflammatory factors have been seen more in women with postpartum depression.

There is also some evidence to suggest that exercise and physical activity have significant benefits in reducing depression symptoms, which are comparable with medicinal benefits.[ 72 ] Moderate physical activity in the third trimester of pregnancy has lowered the postpartum depression scale at 6 weeks after the delivery.[ 73 ]

A possible mechanism is the effect of exercise on mental conditions of women by increasing the endogenous opioids and endorphins, which improve the mental health. Exercise also increases self-confidence and will eliminate negative self-assessments caused by depression. In addition, exercise will help women focusing on the environment around and solving their problems.[ 74 ]

Biological factors and social factors create intertwined rings that each makes women prone to postpartum depression by affecting each other. According to the findings of this study, many biological and environmental factors, such as lifestyle-related factors, are involved in the incidence or prevention of postpartum depression through direct and indirect impact on the level of serotonin in the brain and its function. Furthermore, many environmental factors such as socioeconomic factors cause crisis conditions and postpartum depression through influencing the mental health during pregnancy. Therefore, postpartum depression prevention programs need to focus on individuals interpersonal relationships to reduce domestic violence and increase social protection in addition to modify the women's lifestyle and increase their ability to cope with the crisis conditions. Moreover, based on the results of this research, the postpartum depression predictor tools should focus on social factors and lifestyle in addition to physical health conditions of individuals.

Financial support and sponsorship

This study was supported by Isfahan University of Medical Sciences (Grant Number: 394313).

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

This study is part of a research thesis proposal approved by the Isfahan University of Medical Sciences which was performed with financial support of the Research Council of the University.

What to Do When Weaponized Stories Come Flying at Us

What is an "influence operation kill chain”.

Posted June 4, 2024 | Reviewed by Abigail Fagan

This post is a review of Stories Are Weapons: Psychological Warfare And The American Mind. By Annalee Newitz. W.W. Norton & Company. 246 pp. $27.99.

During World War I, journalist and science fiction writer Annalee Newitz reveals, the U.S. Army established a Psychologic Subsection (soon to be called the Propaganda Section) of its Intelligence Division. The Section prepared leaflets, which were dropped from airplanes, to undermine the morale of German soldiers, while Intelligence Division operatives censored the news at home.

The War Department gave psychological war personnel a permanent home (and the nickname “psyops”) during World War II. A combination of facts, fiction, and advertising hucksterism, backstopped by violence, psyops aimed to influence the minds, emotions, and prejudices of its human targets.

Distributed to service men and women by 1948, Psychological Warfare , by Paul Linebarger, became “a bible on the topic” during the Cold War. The essence of psyops, “as of all good black propaganda,” Linebarger wrote, “is to confuse the enemy authorities while winning the thankfulness of the enemy people,” by spreading anti-communist stories (via, for example, the Voice of America) told by “the mother, the schoolteacher, the lover, the bully , the policeman, the actor, the ecclesiastic, the buddy, the newspaperman, all of them in turn.” Linebarger may also have been the first person to publicly discuss “brainwashing.”

Following a relatively brief discussion of military psyops, Newitz turns to the principal subject of Stories Are Weapons , psychological warfare in American politics and culture. The author covers a lot of ground, including an in-depth examination of micro-targeted ads by Cambridge Analytica, designed to energize heretofore latent racists and authoritarians to vote in 2016 while suppressing the turnout of Blacks and Latinos; Charles Murray’s controversial book, The Bell Curve ; a war over gender identity in a suburban Texas school in 2021; and mental hygiene conflicts over depictions of Wonder Woman in comic books and movies.

Newitz, alas, does not make a compelling case for the usefulness of the term psyops by distinguishing it from myths, propaganda, misinformation and disinformation. Nor does the author indicate whether the intentions of operatives help determine whether they are engaged in a psyop.

Newitz demonstrates, for example, that nineteenth-century New England town narratives about “the last Indian,” newspaper editor John O’Sullivan’s doctrine of “manifest destiny,” Frederick Jackson Turner’s still widely cited “frontier thesis,” and Murray’s claims about the relationship between IQ and race, were factually wrong. But not why each of them, along with U.S. government explanations of Indian removal and Jim Crow laws mandating separate transportation and educational facilities for Blacks and whites, qualify as psychological warfare. Twenty-first-century MAGA culture warriors, according to Newitz, “call for violence against their enemies, just as U.S. military operatives would in a PSYOP product.” But readers will find “psyops” by twenty-first-century liberals and progressives conspicuous by their absence from Stories Are Weapons .

Stories Are Weapons concludes with recommendations for the daunting task of “psychological disarmament.” This process, Newitz emphasizes, requires us to prevent additional misinformation from going viral while opening up spaces in the public sphere for fact-based (but also emotional) “counter-narratives to undermine the legitimacy of weaponized stories.” The Election Integrity Partnership (EIP), a group that includes election workers, cybersecurity experts in the federal government, academics, and non-profits like the AARP and National Conference on Citizenship, for example, has developed “an influence operation kill chain” to identify misinformation, notify social media platforms, and post alerts and propaganda “weather reports” on the EIP website.

But, unfortunately, a “political transformation” essential to disarmament is not now on the horizon. The federal government and social media companies, Newitz points out, do not now agree about whether and how to shut down “ fake news ” and slow down the circulation of content. Citing free speech concerns, the courts have made it more difficult for either or both of them to take corrective action.

“There will always be propaganda,” Newitz acknowledges, and operatives “who want to poison us with paranoia and threaten us with death.” That said, as political and cultural crises intensify, we must do everything in our power to ensure that more and more Americans learn to recognize “weaponized stories when they come flying at us.”

Glenn C. Altschuler, Ph.D. , is the Thomas and Dorothy Litwin Professor of American Studies at Cornell University.

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What to Know About Postpartum Depression (PPD)

It's not just the "baby blues"

Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.

Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments.

Verywell / Theresa Chiechi

Postpartum depression (PPD) is a type of depression that occurs after giving birth. It’s more serious than the “baby blues” as it can interfere with a new mother’s ability to function.

It’s important for new mothers and family members to be on the lookout for signs of postpartum depression. It’s treatable and early intervention can be key to helping mothers feel better as quickly as possible.

It’s completely normal for new moms to feel tired, moody, or overwhelmed after giving birth. But when these symptoms interfere with a new mother’s ability to function and care for their new child, it can be a sign of postpartum depression.

Symptoms of PPD vary from person to person. And they may fluctuate on a daily basis. In general, here are some symptoms that mothers with this condition experience:

• Crying and unexplained feelings of sadness
• Exhaustion yet inability to sleep
• Eating too little or too much
• Unexplained aches and pains
• Sudden changes in mood
• Feelings of disconnect with the new baby and guilt about not experiencing joy
• Difficulty making decisions
• Lack of interest in previously enjoyed activities
• Irritability, anxiety, and anger that sometimes feel out of control
• Trouble concentrating, staying on task, and remembering things
• Feelings of hopelessness and helplessness
• Intrusive thoughts about self-harm or harming the baby

Symptoms typically appear within a few weeks of giving birth, but they may not surface until months later. They sometimes temporarily subside and then resurface.

If you or a loved one are struggling with postpartum depression, contact  Postpartum Support International  at  1-800-944-4773   for information on support and treatment facilities in your area.

For more mental health resources, see our  National Helpline Database .

A physician or mental health professional can diagnose PPD. This diagnosis would be made after an interview and assessment.

Many physicians routinely ask new mothers questions about whether they’ve had thoughts of hurting themselves or their babies and whether they’re feeling down. This is part of the screening process for postpartum depression. 

Physicians may run some tests to rule out any health issues that may be contributing to symptoms. Thyroid conditions, for example, can cause depression.

Once physical health issues have been ruled out, a diagnosis of postpartum depression might be made if the criteria are met.

Treatment for PPD may include medication, therapy, or a combination of both. As of August 4, 2023, the Food and Drug Administration approved Zuranolone as the first oral treatment for postpartum depression. Zuranolone is a once-a-day medication for postpartum depression taken over two weeks.

Antidepressants are also commonly prescribed to treat it. These regulate the chemicals in the brain that manage emotions. But it can take a few weeks for them to take effect. And sometimes the first antidepressant doesn’t work, so a new medication may be tried.

Some antidepressants are safe to take if you’re breastfeeding, but others are not. Your physician will discuss treatment options with you as well as any side effects you might experience. 

Your physician may refer you to a therapist as well. A licensed mental health professional can help you find healthy ways to cope with stress as well as strategies for dealing with depression while you’re caring for yourself and your baby.

Postpartum depression affects up to 15% of mothers. While all the reasons some mothers develop postpartum depression and others don’t aren’t completely known, recent research has identified several risk factors.

Psychosocial risk factors for postpartum depression include:

• Depression and anxiety during pregnancy
• Stressful life events during pregnancy
• Poor social support
• Relationship conflict
• Immigrant status
• Young maternal age
• Low partner support 

Postpartum depression may be related to sensitivity to hormonal fluctuations. Women who previously had the condition are more likely to experience it again after the birth of another baby.

Normal fluctuations in hormonal levels during pregnancy and after delivery can lead to changes in sleep patterns . And these interruptions in sleep can contribute to the onset of postpartum depression. 

One study found that difficulty falling asleep during the first three months after delivery can be a risk factor.

It’s important to seek treatment for postpartum depression . Without treatment, symptoms can worsen.

In addition to experiencing emotional pain, women with postpartum depression are at a greater risk of suicide.   In extreme cases, women with the condition have hurt or even killed their babies.   

If you are having suicidal thoughts, contact the  National Suicide Prevention Lifeline  at  988  for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. 

There’s also a greater risk that mothers with postpartum depression may struggle to form healthy attachments with their babies. This can have longer-term consequences on children and families. And it can also affect a couple’s relationship as well.   

Some people may find that symptoms resolve on their own. Others may have their symptoms cleared with medication, therapy, or a combination of the two. Most mothers feel better after about six months of treatment.   

Reaching out to others for help can be tough, but it is very important when you’re dealing with postpartum depression. 

Many new mothers feel too embarrassed or guilty to tell anyone that they’re struggling. But postpartum depression can happen to anyone after childbirth. So it’s important to remember that it’s not a sign of weakness and it doesn’t serve as evidence that you’re a bad parent.

You might ask someone to help you watch the baby so you can take a nap. Or you may need to tell your partner what kinds of things would be helpful for you right now.

Some people might say, “Let me know if you need anything,” but they may not know how to help. So request that they assist you with household chores or errands if these things seem overwhelming. Or simply let someone know that you need to talk.

It’s important to work on caring for yourself when you’re dealing with postpartum depression. Of course, this can be difficult when you’re caring for your new baby too.

But eating a well-balanced diet, getting a little exercise (once your doctor says it’s OK), and getting adequate rest can help you feel better.

It can also help to join a support group for new mothers. You’ll likely find that many of them are experiencing (or have experienced) PPD as well.

A Word From Verywell

If you think you may be experiencing postpartum depression, talk to your physician right away. Share your symptoms, and talk about your concerns—even though it may be tough to do so. Your physician can assist you in getting the treatment you need to feel your best .

If you are concerned that a loved one may be experiencing postpartum depression, ask them how they are doing. Offer practical assistance or emotional support if you’re able to do so.

U.S. Food & Drug Administration. FDA Approves First Oral Treatment for Postpartum Depression .

Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature . General Hospital Psychiatry. 2004;26(4):289-295. doi:10.1016/j.genhosppsych.2004.02.006

Goyal D, Gay CL, Lee KA. Patterns of Sleep Disruption and Depressive Symptoms in New Mothers . The Journal of Perinatal & Neonatal Nursing. 2007;21(2):123-129. doi:10.1097/01.jpn.0000270629.58746.96

Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum . Archives of Women’s Mental Health. 2005;8(2):77-87. doi:10.1007/s00737-005-0080-1

Mclearn KT, Minkovitz CS, Strobino DM, Marks E, Hou W. Maternal Depressive Symptoms at 2 to 4 Months Post Partum and Early Parenting Practices . Archives of Pediatrics & Adolescent Medicine. 2006;160(3):279. doi:10.1001/archpedi.160.3.279

Paulson JF, Dauber S, Leiferman JA. Individual and Combined Effects of Postpartum Depression in Mothers and Fathers on Parenting Behavior . Pediatrics. 2006;118(2):659-668. doi:10.1542/peds.2005-2948

Meltzer-Brody S, Stuebe A. The long-term psychiatric and medical prognosis of perinatal mental illness . Best Pract Res Clin Obstet Gynaecol. 2014;28(1):49‐60. doi:10.1016/j.bpobgyn.2013.08.009

By Amy Morin, LCSW Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.