"Bathe him, twice thought about letting go of his hand and drowning him, thinking in my mind how deep the water level is theoretically, he will be drowned, if he dies, what kind of death method will I choose..." 」
One mother once revealed her thoughts when her child was three months old.
There is such a group of mothers in Chinese families, who should have welcomed the happy moments of life, but chose to die after the arrival of a new life. "I won't take care of my children, I won't handle my mother-in-law relationship well, and no one will talk to me... I felt trapped in a closed environment, facing infinite inferiority and wandering."
The world knows that women will go through the test of life and death when giving birth, but forget that those women who have a big change in temperament after childbirth may also be close to death again.
Neglected maternal killer
Having a child, for a woman, is the stress of going through the greatest physical and psychological changes in her life.
Netizen "Yuanqi Hot Mom" once left a message:
"Suddenly with two elderly people who have never lived together, there is suddenly a baby in the family who often cries, and the husband has been away for many years without familiar people to accompany him. The roles changed too quickly, and things changed beyond my expectations."
Not only after childbirth, but also depression occurs during pregnancy.
In 2013, in the fifth edition of the American Classification and Diagnostic Criteria for Mental Disorders (DSM-5), the concept of postpartum depression was replaced by perinatal depression, and the different degrees of depressive episodes that occurred during pregnancy and within 4 weeks of postpartum (actually expanded to 12 months postpartum) were classified as "perinatal depression".
Perinatal depression is one of the most common conditions during pregnancy and the postpartum period. More than half of the first episodes will recur within the next 5 years, with 1 in 3 patients having a recurrence even within 1 year.
Image source: Figureworm Creative
Data from the 7th edition of the obstetrics work Obstetrics: Normal and Abnormal Pregnancies show that the prevalence of deep depressive disorder in women (12.0%) is almost twice that of men (6.6%), and a clear spike in depression in women is during childbearing.
According to Japan's September 2018 Maternal Mortality Survey, suicides occurring between pregnancy and postpartum are the highest causes of maternal mortality (28.6%). At the same time, it is pointed out that postpartum depression caused by the uneasiness and stress of raising children is one of the causes of maternal suicide.
In contrast, in China, maternal suicides are not uncommon, in 2017 Yulin, Shaanxi Province, a pregnant woman jumped off a building, on August 30, 2018, a pregnant woman in Zhaotong, Yunnan Province, committed suicide after arguing with her family, etc., people are either indignant at the ruthlessness of their husbands, or indignant at the ignorance of their families, and the real killer behind them - postpartum depression is often ignored.
We don't even know how many moms in China suffer from this depression that accompanies pregnancy and childbirth. At present, there is no large-scale epidemiological survey results for the incidence of such depression in China, and only the 2014 "Expert Consensus on the Guidelines for the Prevention and Treatment of Postpartum Depression" is summarized as follows: "The prevalence rate in China is 1.1 to 52.1%, with an average of 14.7%, which is basically consistent with the current internationally recognized prevalence of 10 to 15%."
Tragedy could have been avoided
Unlike general depression, suicide caused by postpartum depression often includes infanticide, which is called "extended suicide" in psychology - just after childbirth, the mother and the child have not been psychologically separated, and the child is killed when committing suicide, often because the mother cannot bear to leave the child alone in the world to "endure pain".
Tao Ming, chief doctor of the Clinical Psychology Department of Hangzhou Xinhua Hospital, regretfully said that he received very few new mothers who came to the hospital because of depression, and more those who attempted suicide were sent to the psychology department.
"I was impressed by the fact that there was a new mother who jumped into the hospital's music fountain before she was discharged. She held the child and wanted to drown in the fountain, but fortunately the water was shallow and was soon discovered by her family. The other was really miserable, jumping down the 5th floor with the child in his arms, and the adult broke his bones and the child fell to his death."
In the United Kingdom, in 1994, after the release of data on suicide as the leading cause of maternal mortality, various initiatives were launched. After 10 years, the number of suicides decreased significantly, and statistics from the UK from 2003 to 2005 show that suicides ranked second in the ranking of the causes of maternal death within one year after childbirth.
One of the important tools for reducing suicide rates is to conduct depression screening for pregnant women. In China, where there is currently a lack of understanding of depression, only a few hospitals in the north, Shanghai, Shenzhen and other developed areas are carrying out screening and intervention for postpartum depression in the form of pilots, and many areas have not yet begun.
Ding Hui, former vice president of Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University, mentioned: "Pregnant women will have low mood, poor sleep, and poor energy during the postpartum psychological adaptation period, and the symptoms of postpartum depression are similar to the maternal state during this period, so many people mistake postpartum depression for the adaptation period and miss the best time for diagnosis and treatment."
Behind the lack of screening and the difficulty of diagnosing the diagnosis, with the advent of the three-child policy, the accompanying recurrence of postpartum depression may also become a grim situation. According to Obstetrics, re-delivery increases the risk of recurrence of depressive episodes (about 25 to 33%), which is 40% higher than without a history of depression.
New moms don't have to be happy
"Perinatal depression is essentially the same as depression."
Chen Lin, an expert of the Beijing Maternal Depression Intervention Project and director of the depression ward of Huilongguan Hospital, explained to us.
An important biological cause of perinatal depression is drastic changes in estrogen-progesterone levels. In this sense, the prevention and treatment of perinatal depression is not fundamentally different from ordinary depression, and because perinatal depression has a more clear and predictable onset period, it can actually be better prevented.
A mother, Li Lu (not her real name), who was plagued by postpartum depression, told us such a story.
Li Lu's depression occurred during pregnancy, the joy of being pregnant with twins has not yet been extinguished, she began to feel inexplicably uncomfortable, reading books, brushing dramas, visiting the park - the things she used to like to do can no longer arouse her interest, standing on the balcony in the middle of the night, she suddenly has the urge to jump out of the window. She called her mom: "Mom, I think I'm depressed?"
Mom told her over the phone, "I know what's going on, don't panic, don't worry."
Mom moved to her house to take care of her, "she was constantly doing all kinds of things, so I didn't sit idle and didn't have time to think about it." After 16 weeks, Li Lu felt obviously much more comfortable, "I will laugh."
Later, Li Lu learned that there was a promising female teacher in the small town of her hometown, who began to quarrel with her husband and divorce for no reason after becoming pregnant, living with her parents, and finally jumped off a building two months before the child gave birth and committed suicide - after that story, the town's people knew the term perinatal depression.
Xia Xian, deputy chief physician of the Affiliated Obstetrics and Gynecology Hospital of Fudan University, mentioned to us the pressure of social culture:
"When we worked, we found that if this new mother felt that everyone was like this, her heart was much better. And now it belongs to everyone quietly busy themselves, but in front of outsiders, it is a very happy look - like Princess Kate, who has just given birth to a child, radiant, and her body is not out of shape, as if everyone should be like this after giving birth."
"In this case, new mothers will feel that they should have experienced happiness and happiness, but they feel depressed, and then they feel guilty and anxious... It's important that new moms know that unhappiness as a new mom is also the norm, not just yourself."
In 2015, Xia Xian began to explore the screening and intervention of postpartum depression. It took them 3 years to discuss and design a maternal psychological screening process.
In June 2018, the process officially began trial-testing in hospitals.
"Start doing something early in pregnancy, as part of maternal health care, like diabetes to control blood sugar and weight, so that pregnant women also understand that psychological states also need to be controlled, and some very tragic situations after childbirth can be much less." 」 Xia Xian thought so.
In a short film about postpartum depression, a wife bites her lip and says, "You know how hard I feel if I die." More and more people are deciding to do something for moms because they know that when it comes to postpartum depression, "healing starts with understanding."