When Megan Markle discussed having suicidal thoughts during pregnancy in her recent interview with Oprah, it shed light on an issue that remains under-recognized: Many women deal with depression and anxiety. And not just in the postpartum period, but while they are pregnant, too.
Precise numbers are hard to come by, but some estimates suggest depression during pregnancy affects anywhere between 10 and 25% of expectant moms, while others argue that between 20 and 40% of expectant moms live with depression or anxiety.
Regardless of the exact prevalence, it can be extremely serious. An alarming study published in 2020 found a sharp increase in suicidal ideation among pregnant women in the United States in recent years. The researchers behind that study believe their data likely underestimates how common this issue is.
But knowing how to support those who may be struggling during pregnancy can be difficult, as things like depression can show up in many ways ― it’s not strictly outward sadness. It’s also especially hard to spot during the COVID-19 pandemic, as families and friends are spending less time together in-person, especially given that pregnant women and their partners may be playing it particularly safe.
Here are some signs to be on the lookout for, as well as some next steps that might help.
Look for changes in energy level and motivation.
Again, depression and anxiety can present in ways that don’t always seem that obvious to those who don’t work in mental health, and friends and family may not always know exactly what to look out for. (Places like the National Institute of Mental Health website or Postpartum Support International are helpful resources that list many common but under-recognized signs.)
But it can be helpful to tune into whether someone who is pregnant seems to be especially fatigued, disinterested, or just somehow ... off.
One helpful guidepost: “If the friend just doesn’t seem like herself,” that is definitely something to pay attention to, said Nicole Grocki, a Maryland-based clinical therapist and perinatal specialist.
Of course, pregnancy throws many off their routines. And side effects like fatigue are near universal, particularly in the first and third trimesters. But if it seems like a pregnant loved one is really struggling to engage in their usual activities, or is really dragging, that is a potential red flag.
“They may lack motivation, have difficulty concentrating or staying focused,” echoed Rachel Rabinor, a clinical social worker who specializes in perinatal health.
Be on the lookout for irritability and racing thoughts.
In the past few years, a growing number of research studies have captured just how common anxiety (and not just depression) is both during pregnancy and the postpartum period. And it is definitely something friends, partners and other loved ones should be aware of.
Yes, many pregnant individuals worry. But someone who is grappling with anxiety may be unable to stop fretting about their pregnancy or their soon-to-be baby.
“They may be complaining about worries and racing thoughts, irritability, or having trouble sleeping that seems to extend beyond the typical symptoms of pregnancy,” Rabinor said.
Again, resources like Postpartum Support International offer more detailed information about potential signs of anxiety, and may also help connect people to mental health professionals or dedicated support groups. Treatment for any mental health condition during pregnancy may include psychotherapy, medication or a combination of both.
Ask them how they’re doing ― and ask frequently.
Most of our broad cultural narratives around pregnancy paint it as a happy, joyful time, maybe with a few aches and odd food cravings peppered in. But because of that overly simplistic narrative, people may forget to check in on how their loved one is really doing.
“I recommend family members are honest, direct and empathic with their pregnant friend or family member,” Rabinor said. “Asking from a curious place can help them open up and share what’s going on.”
If you’ve noticed that a pregnant loved one is, say, having trouble sleeping or seems particularly fidgety, it can be OK to note that outright.
“Letting them know you feel worried about them because of X, Y or Z is another way to broach the topic,” Rabinor said. “It’s often a relief to know that there’s help and they don’t have to feel this way.”
Help normalize their feelings.
Again, because society tends to expect pregnant folks to be full of joy and anticipation, many who struggle with depression or anxiety report feeling deep shame or embarrassment. They describe feeling bad about themselves because they feel like they “should” be happy and grateful.
For that reason, it can be extremely powerful to simply remind pregnant women who are grappling with mental health issues that it is not their fault. Nor does it make them a bad mom.
Also, remind them they are not alone, and that this is very common. “It’s really, really important to normalize the feelings,” Grocki said.
Offer hands-on support in small ways.
While postpartum care in the United States is anemic, many people do have friends and family who come by soon after the baby is born with precooked meals, or who offer to hold the baby while she takes a shower or nap.
But mental health experts emphasize that it can be equally important to offer those kinds of practical supports when a loved one is pregnant. While a frozen meal will absolutely not take the place of actual mental health treatment, it can help people connect, open up and feel less alone.
“Offer to go on an outing or walk, and if possible to do it consistently,” said Grocki. “Offering simple things to help and show support, like bringing food or groceries or lunch, or even just something to brighten their day like bringing flowers.”
If the pregnant friend has other children at home, maybe offer to watch them for a short stretch (to the extent it’s safe to do so during the pandemic), Grocki said.
“Just show support and care,” she urged.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.