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Postpartum Depression: South Asian Women Suffer in Silence

India West with a NAM Fellowship, News Feature, Sunita Sohrabji Posted: Sep 18, 2008

Editor's Note: Asian Indian women, especially new immigrants, may have a higher risk of postpartum depression. Experts point to the isolation of their immigrant experience, along with the lack of the traditional support system found in their home countries, as possible explanations. India-West was awarded a fellowship from The California Endowment and New America Media to research and report on health issues.

SAN LEANDRO, Calif. -- Poornima Jayaraman knew something wasnt right after the birth of her baby girl last year.

I was so happy when I found out I was pregnant, says the young San Francisco Bay Area housewife, who immigrated to the United States with her husband four years ago. Then Esha came and I was in shock. I wanted absolutely nothing to do with her.

Jayaraman says she was constantly crying, and always angry at the baby and her husband. She would feed Esha irregularly, resenting the constant care she had to provide the newborn. The nonstop cries of her baby only served to further her depression, she says.

Like many immigrant women, Jayaraman spent long hours as the lone caretaker for her baby. Her husband worked equally long hours at his new job, and her mother wasnt able to get a visa to visit until this year. Her in-laws expressed little interest in making the trip. She had made a few friends, but no one intimate enough to talk to about her ordeal.

The breaking point came one day when Jayaraman started uncontrollably shaking her crying baby. I couldnt stand it any longer. I became afraid for myself and for Esha, she says.

Fearing for her childs safety, Jayaraman says she put the baby and her crib in the living room, and locked herself in the only bedroom of the tiny apartment until her husband came home that night and forced the door open.

I dont know how long I was in there, but I just didnt care what happened, she recalls.

While extreme, Jayaramans experience is not as uncommon as it may seem. Several studies report that one out of every 10 women in the United States suffers from postpartum depression, and South Asian womenparticularly newer immigrantsmay be at a higher risk for PPD, because of difficulties adjusting to a new culture, loneliness, isolation and the lack of a traditional Indian support system.

A groundbreaking 2007 study published in the Journal of Obstetrics and Gynecology concluded that 28 percent of Indian American women suffered mild symptoms of postpartum depression and 24 percent suffered major symptoms.

The papertitled Immigrant Asian Indian Women and Postpartum Depression and authored by Deepika Goyal for her masters project at San Jose State University in Californiais the only study of Indian American women and postpartum depression. It surveys the experiences of 58 women who filled out anonymous surveys at doctors offices.

Goyal, a nurse-practitioner in San Jose, Calif., says that only 50 percent of women experiencing postpartum depression are correctly assessed, diagnosed and treated. The disorder, if left undiagnosed, can affect the mother-child relationship and impair a childs development, she adds.

In more severe cases, women experiencing postpartum depression can fatally harm themselves or their children, says Dr. Anandhi Narasimhan, a Los Angeles, Calif.-based specialist in adult, child and adolescent psychiatry.

The mothers mood also affects the babys behavior, she added, which could affect a childs long-term ability to regulate his or her own moods. Such children could become chronically cranky and irritable, says Narasimhan, who serves on the clinical faculty at Cedars Sinai Medical Center.

Dr. Nirmaljit Dhami, medical director of the new Maternal Outreach Mood Services program at El Camino Hospital in Mountain View, Calif., says that post-birth, many women present symptoms of tearfulness and crying. Sadness, emptiness, feeling overwhelmed, having a short temper, appetite changes and withdrawal from family and friends are all symptoms common to postpartum depression.

In more extreme cases, women are afraid to be alone with their babies for fear of deliberately hurting them, says Dhami, who is the mother of toddler-age twins. There are also bonding issues: a mother might feel disconnected from her baby.

People have many more resources in India, including cheaply available help and family to pitch in. Here, the most helpful person is a long-distance phone call away, says Dhami.

Indian American women are also unlikely to seek treatment for depression, said Dr. Kaveri Patel, a family practitioner in Fremont, Calif., who sees a number of South Asian women in her practice. Women raised within South Asian families are not typically taught or encouraged to discuss emotional distress for cultural reasons, Patel says. The stigma of having a mental illness is huge in the South Asian community and it keeps women away from getting the care they need.

Some Indian immigrant women also live in abusive homes, which compounds their risk for postpartum depression, and also their inability to seek help, says Narasimhan.

Kirti Parikh (name changed upon request) went undiagnosed with postpartum depression for about 10 months, until she saw a friend who was experiencing the same symptoms.

That visit suddenly made me realize that I was suffering from PPD and anxiety as well, says the occupational therapist from Baroda, who now lives in Mountain View, Calif. I had started to feel anxious and depressed within the first month, but was in denial.

I didnt want my daughter. I wanted my old life back, she says, adding, It took about two years for me to appreciate her spirit as the biggest blessing in my life.

I expected motherhood to be different than what it actually was. My inability to accept this major life change was the single biggest factor in my depression.

Unlike many Indian American women, Parikhs family was available to help after the birth of her daughter. Her mother came from India and her husband worked from home for the first three months.

But the presence of relatives only added to Parikhs stress. They could not understand why I was so irritable and stressed, despite their support, she recalls.

Shazneen Gandhi, a commercial litigation attorney from Los Angeles, also knew something was not right after the birth of her daughter Shayaan, who is now nine months old.

I felt extremely responsible for Shayaan and yet there were times when I just wanted to get away from her, says the Mumbai-born Gandhi, who has not returned to her practice since the birth of her daughter.

I went through a mourning period, lamenting the loss of my earlier lifestyle, feeling isolated and alone and cut off from the world, she says, adding, And then on top of that, feeling guilty for feeling this way, because I had wanted a child for so long and finally got my wish when Shayaan was born.

Gandhi says she compensated by being extra tender to her daughter and handing her off to her husband or mother when she could no longer handle her.

A huge challenge was Gandhis inability to breastfeed Shayaan. Much of her depression was relieved when she finally sought help from the Pump Station in Santa Monica, Calif., she says.

Manisha Mathurs (name changed upon request) postpartum depression began almost immediately after she delivered her baby boy by an emergency C-section. I had a lot of anger and insecurity for some reason, she recalls.

Mathur, who recently returned to work as a buyer in the apparel industry, says she would uncontrollably lash out at her own mother when she experienced stress. I regretted it so much later. Sadly, my family was my punching bag during my hard times.

The new mother found herself frustrated by the medical system and sought out resources on the Internet to help her with her depression. Mathur recommended the book, What to Expect When Youre Expecting, and babycentre.com, which have postpartum depression resources.

Several cultural factors may explain why a greater number of Indian American women experience postpartum depression.

One of the biggest reasons is the lack of social and family support. In India, women are expected to stay confined to their homes for six to eight weeks or may go to their mothers home in the weeks before and after childbirth.

Care of the newborn is assumed by other women in the house, usually extended family, explains Goyal, adding that mandated rest and assistance from relatives are key components in prevention of depression.

Many South Asian women who have moved to the U.S. have left all or part of their extended family behind, says Patel, adding, Their husbands may have full-time jobs that further contribute to their feelings of loneliness and isolation.

In several studies conducted in India and Europe, giving birth to a female infant was directly related to postpartum depression. There is great pressure on women to produce a male heir, especially for women who already have one girl child, the studies concluded.

The initial process of acculturation for new immigrants can also be linked to postpartum depression.

The struggles of fitting into a new society and the isolation many women feel increases stress, which can result in mood disorders, says Narasimhan. She has found that key factors in successful acculturation include community support, places of worship and the company of other women.

Genetics can also play a role. If your mother and grandmother suffered from postpartum depression, its likely you will as well, Narasimhan says. Other physical factors for postpartum depression include hypo-thyroidism and anemia, both prevalent among South Asian women.

The Maternal Outreach Mood Services program at El Camino Hospital is one of two such clinics in the country. Patients are referred to the clinic or contact the clinic through its Web site. An initial hour-and-a-half-long phone interview determines what level of care a woman might need.

At the higher level of care, patients are admitted into a five-days-a-week program, which concentrates on self care, relaxation and communication skills, realistic expectations of motherhood, couples' and family conflicts, enhancing mother-baby attachment and stress management.

Narasimhan begins by mitigating any obvious stress factors for patients experiencing postpartum depression. If she doesnt have any help or support, we figure out how to get it for her, she says.

It is also crucial to get an accurate picture of how safe the baby is. Women frequently do not say how theyre feeling about their baby because they feel guilty about it, says Narasimhan.

Anti-depressants are used in more severe cases of postpartum depression, Narasimhan and Dhami say, adding that such medications must be used sparingly as they can affect the baby through the mothers breast milk.

Postpartum depression is more than just the blues, explains Narasimhan. Its not just something you can shake off. The good news is that it is very treatable, once its diagnosed.

The critical factors to getting proper treatment are educating women beforehand to the symptoms they may experience post-birth, she says, as well as educating husbands and in-laws to be supportive of a womans need to get care.

Related Articles:

New Coalition Highlights Needs of South Asian Communities

Health: Asians Get Depressed, Too

When Psychological Problems Hit Asian Immigrants

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