Mental Health in Motherhood and Parenting

Some research estimates that postpartum depression affects approximately 35% of mothers within the SCI population, as compared to 13% of women in the general maternal population (Chung et al. 2007; Ghidini et al. 2008). A case-control study found that women with SCI were 7 times more at risk for postpartum depression related hospitalization (Crane et al. 2019). Most recently, an international retrospective survey of 102 women revealed that 75% of women with cervical SCI screened positively for PPD using scales from the Pregnancy Risk Assessment Monitoring System, but only 10% were clinically diagnosed (Lee et al. 2021). The same study reported that only 7% of women with SCI below T7 were diagnosed with PPD, despite 25% scoring positive for a clinically relevant degree of PPD symptoms. Additionally, a cross-sectional survey of 287 women found that mothers with physical disabilities reported being diagnosed more frequently with depression before (39% vs. 16%), during (25% vs. 7.6%), and after (30% vs. 10%) their pregnancy compared to mothers without disabilities, and they also reported more PPD symptoms after controlling for pre-pregnancy depression diagnosis (Mitra et al. 2015).

Discussion

Crane et al. (2019) found that postpartum depression (35%) was the most common complication in the puerperium. There is a higher incidence of post-partum depression in women with SCI. Women with SCI have a 7.36-time higher chance of hospitalization due to PPD than the general population (Crane et al. 2019; Lee et al. 2021; Mazzia & Berndl 2023). Women with lower-level injuries are significantly associated with PPD (p=0.012) and MDD (p<0.005) (Lee et al. 2021). Among the 37 pregnancies resulting in deliveries, 16 (43%) were scared about being pregnant, 17 (46%) were worried about child care, seven (19%) did not have adequate support at home, 13 (35%) had postpartum depression, two of whom (5%) required therapy, and two (5%) regretted being pregnant (Ghidini et al. 2008). Rates of self-reported postpartum depression (PPD) evaluated by the Pregnancy Risk Assessment Monitoring System-3D tool (PRAMS-3D) ranged from 25-37% (up to 4 times greater than prevalence of clinically diagnosed PPD in this sample; Lee et al. 2018).

Stress may play a smaller role in chronic SCI once the individual receives the support needed to adapt to living with their injury. It has been suggested that women who are pregnant or in the early postpartum period are more susceptible to developing galactorrhea. Galactorrhea symptoms may add stress for mothers with SCI as breastfeeding is an important part of establishing the emotional bond between mother and child and has been described as an incredible experience of intimacy (Kronborg et al. 2015). The emotional closeness facilitated by breastfeeding has important health implications; mothers who continued to breastfeed for six months postpartum experienced reduced rates of PPD, which is a benefit in reducing adverse child outcomes and linked to a child’s social and behavioural development (Mohamad Yusuff et al. 2015; Brummelte & Galea 2016). Early assessment is recommended to prevent missed diagnosis of PPD (Lee et al. 2018).

Conclusion

There is level 2 evidence (Gulick & Kim 2004) that social support decreases emotional distress at 1 month but not at 3- or 6-months post-birth.

There are 2 studies with level 3 evidence (Crane et al. 2019) level 5 evidence (Lee et al 2021) that there is higher prevalence of PPD in women with SCI.

There is level 3 evidence (Crane et al. 2019) that women with SCI experience longer hospitalizations and rates of rehospitalization for postpartum depression or injury compared to non-SCI controls.

There is level 5 evidence (Ghidini et al. 2008) that only a small fraction of women with SCI receives information about pregnancy during rehabilitation (20%) and find it useful (10%) There is need for increased education on breastfeeding after SCI.

There is level 5 evidence (Lee et al. 2021) that mothers with SCI (particularly high-level) may have increased risk of PPD, and that self-reported PPD was higher than clinically diagnosed PPD.