Postpartum Depression in Hong Kong: Expert Guide

Life in Hong Kong runs at a frenetic pace. There’s a lot of pressure on people in the city to aim for a promotion, hit the hottest restaurant, and wear the latest labels. The hustle and bustle of the city can lead people to feel lonely and it’s not always easy to find space and time to reflect and seek support. Add to that, the idyllic image our society pushes of a beautiful, blissful and natural motherhood and it’s a lot of pressure on expecting and new mothers. It can be an anxious time for even the most even-keel woman. Unfortunately, postpartum depression remains taboo in Hong Kong as in other places. It’s important to keep in mind that a mother’s mental health is as important as her physical well-being.

Two conditions are common: the “baby blues” and postpartum depression. We spoke with clinical psychologist, Dr. Quratulain Zaidi about mental health after childbirth, what to look out for in yourself and loved ones, and where you can look for help.

Baby blues vs. Postpartum depression

Prevalence and causes of the “baby blues” 

The “baby blues” affect 40-80% of women in Hong Kong. They’re often attributed to the sudden hormonal shifts that occur in the days and weeks following childbirth as your body adjusts from being pregnant. Recovering from birth and adjusting to a new family composition can be stressful and isolating.

Signs and symptoms of the “baby blues”

The onset of baby blues is typically 2 to 3 days, but no more than 2 weeks, after birth. You might feel tearful, emotionally fragile, overwhelmed, irritable and have trouble sleeping. Symptoms usually taper off after two weeks.

When and where to seek help for the “baby blues”?

The symptoms are usually transient and settle on their own. Seek help from your obstetrician, general practitioner, midwife or psychologist if the symptoms persist after 2 weeks and the severity of feelings increases.

Treatment for the “baby blues”

Treatment for the “baby blues” will usually consist of counseling with your obstetrician, general practitioner, midwife or psychologist and checking in to ensure symptoms aren’t prolonged and escalate to post-partum depression.

Causes of postpartum depression

Globally, 10-20% of women are diagnosed with postpartum depression (PPD) – in Hong Kong, the rate is one in ten. It’s quite possible that many more women will experience symptoms of postpartum depression but will go undiagnosed. It’s important not to underestimate the issue. We don’t really know why some women are more or less predisposed to PPD but it’s likely that, similar to the “baby blues”, the stress of sleep deprivation and postpartum hormonal changes have an effect.

Signs and symptoms of postpartum depression

The onset of postpartum depression takes a little bit longer than the “baby blues” to surface. It can occur at any time in the first post-partum year and can come and go in waves. The symptoms are similar to “baby blues” but more severe and with a later onset. These can include any combination of the following:

• Sadness and feelings of helplessness
• Frequent crying
• Insomnia
• Appetite changes
• Difficulty concentrating or making decisions
• Feelings of worthlessness
• Racing thoughts
• Agitation or persistent anxiety
• Anger, fear or feelings of guilt
• Obsessive thoughts of inadequacy as a person or parent
• Lack of interest in usual activities
• Lack of concern about personal appearance
• Feeling a loss of control
• Feeling disconnected from the baby
• Possible suicidal thoughts

When and where to seek help for postpartum depression?

Consult someone as soon as possible. It’s a really challenging time in life and you don’t have to face it alone. Postpartum depression is associated with reduced mother-infant bonding, decreased breastfeeding outcomes and other negative impacts on the mother, infant and family. Early intervention is important for you and your family’s well-being. With support from family and professionals, most women fully recover and resume normal lives.

All mothers should be assessed for postpartum depression as part of their postpartum care, regardless of whether they are seen in the private or public health system. The most common measures are Edinburgh Postnatal Depression Scale and the Center for Epidemiologic Studies Depression Scale. If you feel any of the above symptoms, speak up and make yourself heard, even before you’re measured.

Treatment of post-partum depression

In some cases, medication is needed to assist with a chemical imbalance. However, studies show cognitive behavioural therapy and medication is the most successful treatment for PPD.

In the public health system, this is part of the Comprehensive Child Development Service at your assigned Maternal and Child Health Centre (MCHC). An MCHC nurse will initial counselling and then refer you on to a social worker or Hospital Authority Psychiatric services for additional support. If you’re going through the private system, you will likely be assessed by your obstetrician, GP, or midwife for PPD as part of your normal post-partum care. If necessary, you will be referred to a psychologist who has experience with PPD. You can also self-refer to a psychologist if you require support. Remember that freedom of choice is part of what you’re paying for in the private system – make sure to find a psychologist who is a good fit for you!

Preventing post-partum depression

If you have had PPD or other depression previously, or are predisposed to feeling anxious, it’s important to take steps before baby arrives to try to prevent PPD. These include:

• Preparing your family, house, and finances to accommodate a new baby.
• Having realistic expectations for the challenges of parenthood. 
• Developing strategies to ensure you get enough sleep. If you’re breastfeeding, this can be challenging. Perhaps have your partner, helper or a family member take the baby out of earshot for a few hours in the morning of unbroken sleep. 
• Seek out other mothers and couples with babies of a similar age to feel less isolated. 

If you experience one or more of these symptoms, seek psychological support. Delaying counseling or medical treatment could put you and your baby at risk.