Loneliness is central to perinatal depression

Loneliness can often contribute to depression in expectant and new mothers, finds a new review of evidence led by UCL researchers.

The researchers say people working with expectant mothers, such as in antenatal classes or consultations, should be aware of the importance of loneliness and the value of encouraging new mothers to develop and maintain good social connections. The findings suggest that increased support from family and healthcare professionals can be helpful in reducing the mental health impacts of loneliness.

Published in BMC Psychiatry, the meta-synthesis (an evidence review using a systematic method) of qualitative research pulled together accounts from 537 women, from 27 research papers on four continents.

Lead author Dr Katherine Adlington (UCL Psychiatry and East London NHS Foundation Trust) said: "We found that loneliness was central to the experiences of expectant and new mothers with depression. We know that depression and loneliness are often interconnected - each one can lead to the other - and this may be particularly true for perinatal depression.

"Having a baby is a period of huge transition and upheaval, that can involve losing touch with people and existing networks, such as work colleagues. This research suggests that loneliness is a major risk for mental health problems during pregnancy and for new mothers."

Depression is common during the perinatal period, affecting one in six pregnant women and one in five women during the first three months after birth, and can significantly affect new parents’ quality of life and can have long-term adverse impacts on their child’s cognitive and emotional development.

For this review of evidence, the authors found that while very little research has been conducted specifically investigating loneliness in perinatal depression, loneliness came through prominently across the studies as a key contributing factor.

Some of the causes of loneliness included stigma, self-isolation, emotional disconnection and not receiving enough support. Many women reported a fear of judgement as a ’bad mother’, and both perceived and experienced mental health stigma, which contributed to them hiding symptoms of mental ill-health and often led to self-isolation and withdrawal.

Many women also reported a sudden sense of emotional disconnection after birth, from their previous lives before getting pregnant, from other mothers, and from the baby. Others also reported a mismatch between expected and actual support provided by their partner, their family, and their community more broadly. The researchers also identified a double burden faced by mothers from disadvantaged communities, due to increased stigma and decreased social support, highlighting the need for more targeted support that is culturally appropriate and without language barriers.

The review also shed light on potential solutions. Many women reported that validation and understanding from healthcare professionals was helpful and may alleviate their loneliness, suggesting that clinical staff may have a greater than expected impact on reducing loneliness.

Peer support from other mothers with experience of perinatal depression was also helpful - but only if those mothers had similar stories to share, as speaking to mothers who appeared to be doing well could in fact make loneliness worse.

Senior author Professor Sonia Johnson (UCL Psychiatry and Camden and Islington NHS Foundation Trust), who co-leads the Loneliness and Social Isolation in Mental Health Network at UCL, said: "Helping women to understand early on in pregnancy how common loneliness is, and how it can lead to mental health problems, and that it’s okay to feel such feelings, could be an important way to reduce the impact of perinatal mental ill health.

"We found that healthcare professionals also have an important role to play in helping women to feel heard and validated in their experiences of loneliness, so we would suggest that asking expectant and new mothers about potential feelings of loneliness could be highly beneficial, in addition to signposting them to peer support.

"Peer, social and family support are likely to be crucial in reducing perinatal depression; this study helps understand the importance of social connection at this time, but there is a lot more to be done to understand why loneliness is so important in the perinatal period, and to develop effective ways of preventing or reducing it."