We've all heard about postnatal depression, but what about antenatal depression?

We all know and hear a lot about postnatal depression, but what about depression and anxiety during pregnancy?

Over the past two decades, most research on mothers’ mental health has focused on the time after childbirth. Only recently has attention turned to the issue of maternal mental health during pregnancy.

Our study involving 1500 first-time mothers suggests around one in ten mothers have clinically significant depressive symptoms in the first three months of pregnancy, and a similar proportion have severe anxiety symptoms.

Other studies measuring symptoms at later stages of pregnancy, or over a number of time points, indicate even higher proportions of women have clinically significant depressive and/or anxiety symptoms during pregnancy.

Women who have depressive symptoms during pregnancy are also much more likely to have anxiety or depression after childbirth. Although it’s important to point out not all women who have these symptoms during pregnancy go on to have mental health problems after their baby is born.

So what is antenatal depression?

Pregnancy can be an unsettling time for women and men. It’s common for women to feel overwhelmed by the extreme fatigue, and physical and emotional changes associated with pregnancy.

There are many ways symptoms of depression and anxiety can manifest. Some women have difficulty making decisions or managing everyday tasks. Others become extremely anxious and may have panic attacks. Others feel numb and may not want to see family or friends.

All pregnancies are a “journey into the unknown”. Most women and men will experience some anxiety as a normal part of getting ready to welcome a new baby. While some anxiety is normal, debilitating anxiety is not.

What can cause antenatal depression?

The causes of depression and anxiety during pregnancy do not differ much from the causes at other times. Common causes are lack of social support, financial stress, relationship difficulties and stressful life events, such as moving house, or something bad happening to a close family member or friend.

Factors specific to pregnancy include: unintended or poorly timed pregnancy, and pregnancy complications such as severe morning sickness, a history of miscarriage or preterm birth.

Victorian research shows one in five women experience emotional and/or physical abuse by an intimate partner in the first 12 months after giving birth; a similar proportion are afraid of their partner during pregnancy. This translates to 14,000 Victorian families a year affected by family violence during pregnancy and in their child’s first year of life.

Women who are afraid of their partner during pregnancy are markedly more likely to have antenatal anxiety and depression. They are also more likely to have other adverse outcomes, such as bleeding during pregnancy, preterm birth, low infant birthweight or stillbirth.

Why it may be hard for women to seek help

Pregnancy is a time when women have a lot of contact with health services. Australian guidelines recommend a minimum of ten visits to a health professional for women having their first baby, and at least seven visits for women having their second or a subsequent baby. Despite this frequent contact, many women experiencing depression and anxiety during pregnancy do not disclose this to health professionals.

The reasons vary. Women may be reluctant to talk about their symptoms because they feel embarrassed about seeking help, or may not feel confident to talk to a health professional about what they’re experiencing.

Our research with first-time mothers shows women are more comfortable talking about depressive symptoms than anxiety. In part, this may reflect the greater media attention given to postnatal depression.

Some women taking part in our research regarded their symptoms as “normal”, “to be expected” or “not severe enough” for them to seek professional help. Women may tend to minimise psychological problems in the context of motherhood. They may also fear their capacity to care for their child may be questioned.

Getting it right in the first 1000 days

The first 1000 days – the period from conception to age two – is recognised as the time when foundations are laid for health across the lifespan. If we don’t get it right in this period, there are lifelong costs to individuals, families and communities.

The World Health Organization recommends routine screening during pregnancy to identify women experiencing or at risk of experiencing emotional or physical abuse.

The good news is there’s a window of opportunity in the first 1000 days to do things to support women and families that can have long-term effects on the health and well-being of future generations of Australian children.

The clustering of risk (child and adult experiences of abuse) and accumulation of risk factors within families (family violence and other stressful events, such as financial hardship, combined with poor mental health) means some women and children may need more intensive responses.

For other women, anxiety and depression during pregnancy may occur for other reasons, and require different responses. Tailoring support to suit women’s circumstances is crucial to improving maternal and child health outcomes in the longer term.

Anyone at risk of family and domestic violence and/or sexual assault can seek help 24 hours a day, seven days a week, either online or by calling 1800 RESPECT (1800 737 732). Information is also available in 28 languages other than English.

If this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 44 or beyondblue on 1300 22 4636.

Parenting advice and resources are available from the Raising Children Network.

Stephanie Brown receives funding from the National Health and Medical Research Council.