What Is Perinatal Depression?

Perinatal depression refers to depression that develops during or after childbirth (as opposed to postpartum depression, which is depression that develops only after delivery). Perinatal depression is more than just "the baby blues" or the normal feelings of distress that can accompany having a new baby. Rather, it is a potentially serious psychiatric condition that could impair a mother’s ability to function and negatively affect the health of her child.

Depression is one of the most common and serious complications during the perinatal period. Studies suggest 17% of pregnant women develop depression during their pregnancy and 13% experience depression afterwards.¹

Perinatal depression is included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, the standard classification used by mental health and other professionals. Its signs and symptoms are nearly identical to those for depression that is unrelated to pregnancy. The American Psychiatric Association (APA) describes the symptoms of perinatal depression as:²

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Increase in meaningless physical activity (e.g., pacing, handwringing) or slowed movements or speech
• Feeling worthless or guilty
• Difficulty thinking, concentrating, or making decisions
• Thoughts of death or suicide
• Increased tearfulness
• Lack of interest in the baby, not feeling bonded to the baby, or feeling very anxious about/around the baby
• Perceiving oneself to be a "bad mother"
• Fear of harming the baby or oneself

How Perinatal Depression Affects Employees and Employers

Physical Effects

Because the signs and symptoms of perinatal depression essentially mirror those of depression, its potential negative effects on the body are similar. For instance, people with perinatal depression might have:^3,4

• Sleep problems
• Unhealthy changes in weight (either losing or gaining)
• Chronic pain (e.g., musculoskeletal pain)
• Headache
• Gastrointestinal upset
• Fatigue or lethargy
• Decreased sex drive

Medical conditions associated with perinatal depression include autoimmune illnesses, obesity, diabetes, and migraine.^5,6,7 Untreated depression during pregnancy can also lead to health complications and poor pregnancy outcomes, including preeclampsia, preterm delivery, and low birth weight.⁸

Psychiatric and Functional Effects

People with perinatal depression experience excessively sad moods and an inability to enjoy activities they normally find pleasant. They also may experience lack of motivation, hopelessness, feelings of guilt or worthlessness, and reduced self-confidence and self-esteem, particularly as it relates to their ability to be a good mother.⁹

As noted above, there is an elevated risk of suicide among women with perinatal depression. In a study of more than 950,000 mothers, those with perinatal depression had triple the risk of suicidal behaviors over 18 years compared with their siblings without perinatal depression.¹⁰

Work-Related Effects

Being pregnant or having recently had a baby is its own source of stress that can make it difficult for any employee to thrive at work. The additional burden of experiencing depression during the perinatal period significantly increases the chances of an employee struggling in the workplace.

Consider the following examples of adverse work-related outcomes associated with perinatal depression:

• Presenteeism — The annual costs per person attributed to presenteeism among women with untreated perinatal mood and anxiety disorders (including depression) was $2,871 in 2017.¹¹
• Absenteeism — The annual costs per person attributed to absenteeism among women with untreated perinatal mood and anxiety disorders was $888 in 2017.¹²
• Unemployment — related productivity loss—The per-person loss of economic output attributable to increased unemployment among women with untreated perinatal mood and anxiety disorders was $40,478 in 2017.¹³

Tips for Employers: How You Can Help Employees with Perinatal Depression

Work participation allows perinatal persons to experience healthy self-esteem, increased social support, and greater financial resources. However, the transition back to employment after childbirth can be fraught with stress, confusion, and questions—all of which only compound an already stressful time and increase the likelihood of perinatal depression in vulnerable persons. Businesses serve as a powerful point of contact in helping pregnant and postpartum persons stave off mental distress.

Potential strategies are numerous and can include the following:

• Knowing what to look for. Do not assume that a person with peripartum or postpartum distress will actively seek help if needed. They may avoid disclosing symptoms out of fear of stigma, being judged as an "unfit" mother, or having their child removed from the home. Referral to the company’s employee assistance program (EAP) can increase the chances of all people receiving proper screening, diagnosis, and mental health care as needed.
• Helping to promote earlier screening. Timely identification of depression can lead to earlier treatment and better outcomes. Ensure EAPs have access to screening tools. Benefit directors can ask their healthcare plans to encourage providers to engage in screening and can ensure that plans include coverage of well-baby and well-child visits.
• Prioritizing information. Employers have ample opportunities to supply workers with much-needed information about perinatal mental health but should not wait until after delivery to provide these resources. Once an employee has notified supervisors that they are pregnant, information about mental health concerns can be provided:
  • During human resources–employee meetings on coordination/continuation of benefits and leave options
  • When an employee is completing maternity leave/disability leave or return-to-work paperwork
  • Online, through the company’s intranet (this information should be placed in proximity to the company’s leave policy for ease of location)
  • Through informational handouts in the company’s lactation room
  • During occupational services, such as wellness fairs and flu-shot clinics
  • On hand with EAPs for use during referrals for pregnancy-related distress
• Making sure employees know their rights. Not all employees know the rights afforded them by the U.S. Equal Employment Opportunity Commission (EEOC). Employers must make the same allowances, such as extended unpaid leave or workplace accommodations, to people with pregnancy-related disabilities as they do to employees with other ADA-covered disabilities.
• Calculating the feasibility of providing extended, or even paid, maternity leave. Research has found an association between longer maternity leave and a lowered risk of perinatal depression in high-income countries such as the U.S.¹⁴ However, an extension might not be a realistic option for people who are taking unpaid leave, particularly if they are the sole wage earner in their household.
• Helping to create a more supportive environment. Social support, including in the workplace, has been shown to buffer against perinatal depression.¹⁵ Employers can assist by cultivating an attitude of acceptance and empathy, rather than one of judgment, about peripartum and postpartum distress. Work-based support groups can provide education and coping techniques while giving workers struggling with mental health symptoms a place to feel validated.

Resources

Managers, supervisors, and other employers can learn more about perinatal depression in the workplace through the following resources.

• The Job Accommodation Network provides accommodation ideas for employees with postpartum depression.
• A Better Balance (.pdf), a national nonprofit legal advocacy organization dedicated to work–family justice, developed guidance about workplace rights for employees with perinatal depression.