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    The Silent Struggle of Having Postpartum Depression in China

    Doctors are diagnosing more and more new mothers with the condition, but low public awareness and social taboos remain barriers to recovery.
    Jul 12, 2018#health#family

    BEIJING — Sometimes, Cheng Qian looks down at her baby boy and wonders why she brought him into the world at all. Seven months after giving birth, she is still struggling to overcome the symptoms of postpartum depression. “I cry easily and quickly lose control of my emotions,” she says. “Even at work, I’ll burst into tears during a meeting and can’t explain why.”

    Cheng’s mental health issues are far from unique: In China, around 15 percent of new mothers are diagnosed with postpartum depression, and up to 85 percent of mothers may experience depressive feelings after giving birth, the country’s medical experts say. Although both of these figures are broadly in line with global averages, Chinese public awareness of postpartum depression is low, and deep-seated taboos about mental health issues mean that many women do not seek psychological help, avoid medical treatment, and receive little support from their families. In some cases, the condition is an aggravating factor of self-harm and suicide.

    Cheng’s symptoms did not appear immediately. On the day her son was born, her overriding emotion was relief, the 34-year-old says. Three years prior, she had undergone an abortion late into another pregnancy after the child had developed profound brain defects — an experience that left her physically exhausted and mentally scarred. “The birth of a healthy baby meant a lot to my whole family,” she says. She nicknamed her son Yuanzi — “little round boy” — in the hope that he would grow up cute and well-fed.

    But any happiness proved to be short-lived. In the weeks and months that followed Yuanzi’s birth, Cheng found herself unable to produce enough breast milk to maintain his healthy growth. Although she also bottle-fed her baby, doctors later diagnosed him as underweight. Cheng says the situation enraged her mother-in-law, who had moved in with her family after Yuanzi was born.

    “She had me eat pork trotter soup, silver carp soup, durian — all the foods that advertisers say will stimulate breast milk production. But none of them worked,” Cheng says. “Then she blamed me for my unhealthy lifestyle, because I tended to stay up late at night and had previously gone on diets to lose weight. She said [my lifestyle] fundamentally impacted my physical health.”

    Cheng read several parenting books during Yuanzi’s first few months, but her mother-in-law had her own, more traditional ideas of how to raise him. The older woman swaddled the boy in thick quilts and added salt to his food to encourage Yuanzi to eat more. Cheng worried that her mother-in-law’s techniques would make her son overheat or fall sick: Most infants are unable to effectively process salt until after the first year, and excessive salt consumption can damage their kidneys.

    “Every time we argued about things, she would always insist that she had raised several kids, that in her day everyone looked after babies like that, and that her children had all turned out healthy,” Cheng says of her mother-in-law, adding that her husband often chose to work overtime rather than involve himself in domestic conflicts.

    Disturbingly, as the months went by, Cheng’s frustrations increasingly focused not on her mother-in-law, but on her child. “Sometimes, I can’t help but blame my baby for the miserable life I’m leading now. If he wasn’t here, my mother-in-law wouldn’t have moved in with us and I’d never have gone through all those arguments at home,” Cheng says. “She wants to make all the decisions, so I just leave the child to her.”

    Five months after giving birth, Cheng decided to go back to her job at one of China’s state-owned enterprises, convincing herself that staying away from her aggressive mother-in-law and crying baby would relieve her depression. But even at the office, she couldn’t escape her negative feelings, and frequently quarreled with her bemused colleagues over trivial matters.

    In the seven months since Yuanzi was born, Cheng says she has received most of her emotional support from an online community of around 500 other mothers with postnatal problems on social messaging app QQ. Members of this group first encouraged her to talk about depression with a therapist, but Cheng initially hesitated to do so. In her hometown of Zibo — a city of 4.7 million people in eastern China’s Shandong province — the only mental health center was at a large public hospital with communal waiting rooms, short consultations, and scant privacy. Cheng worried that if anyone at the center recognized her, rumors would spread that she was mentally unstable, and she would be shunned.

    Instead, Cheng visited a private psychiatrist in Beijing — a three-hour train journey away from Zibo. Although the psychiatrist held one of the country’s highest certifications for mental health professionals, Cheng says, “she told me she was unable to help me through my condition.” Cheng’s symptoms were apparently so severe that they required medical intervention, not conventional counseling. But because the psychiatric clinic was unaffiliated with a hospital, Cheng could only be referred to a public institution for a formal diagnosis and prescription.

    When Zhao Qian started practicing medicine 12 years ago, virtually no women approached her with Cheng’s condition. “But nowadays, we have a steady inflow of patients exhibiting signs of postpartum depression,” says the doctor, who works at Beijing Anding Hospital’s Depression Treatment Center. “This shows that awareness of the disease is growing.” Earlier this year, the hospital reported that total patient admissions to its Depression Treatment Center — including those with postpartum depression — is growing at an annual rate of 20 percent.

    Nonetheless, many patients feel deep shame in admitting that they have a mental health disorder, Zhao says. Consequently, they may refuse to take prescribed antidepressants or stop taking them before the end of the course of treatment, leading to high relapse rates. Cheng, too, has no plans to follow up on her counselor’s hospital referral. “No, I won’t go,” she says. “I simply need to pour out my feelings to someone, then I’ll be back to normal.”

    Huang Lili, a Beijing-based obstetrician-turned-psychologist with more than 20 years of experience, believes that China’s social environment may exacerbate postpartum depression. Most of today’s new mothers were themselves born in the 1980s and ’90s: They were not just only children showered with huge amounts of attention and care, but also grew up as part of China’s most individualistic generation in living memory. When she also factors in the advances that the country has made in the provision of mental health services, Huang is not surprised that she sees far more reports of postpartum depression today than when she first started working.

    “When the whole family shifts its focus from you onto your newborn baby, these young women have to mentally adjust. Some of them feel extremely depressed, because they’re no longer the most important person in the family, and they’re not treasured as much as before,” Huang says. “Young women need help before they give birth in order to understand how their roles are about to change.”

    Although the concept of postpartum depression was first explained in the British Journal of Psychotherapy in 1968, its exact causes remain unknown. Doctors suspect that fluctuating hormone levels during pregnancy can trigger the onset of depressive symptoms after birth — including, but not limited to, low mood, fatigue, poor concentration, loss of appetite, and insomnia.

    Shen Huixin — a Beijing-based psychological counselor who has offered her assistance to over 200 families dealing with postpartum depression — says that many such clients have similar family backgrounds. Often, they have underestimated how having a baby would fundamentally change their lives, complain that the child’s grandparents take an excessively traditional approach to parenting and don’t lend psychological support to the new parents, and say that the fathers lack basic child care knowledge and so saddle mothers with the burden of raising the baby.

    “Most of my clients also reject my suggestion that they visit hospitals for drug interventions,” says Shen. “And some people who do take my advice feel sad that their symptoms get better when they take medicine. They believe that means they are crazy.”

    Although reports on postpartum depression are increasingly appearing in the Chinese media, most outlets discuss it as a factor in high-profile cases of self-harm and suicide. In mid-June, a woman in Mianyang — a city in southwestern China’s Sichuan province — drowned herself together with her 10-day-old son. Her family, who first reported her missing, told police that she had seemed depressed since giving birth. And in January last year, a 31-year-old mother in Hunan province threw herself from a high-rise apartment block while holding her two-year-old son and infant daughter, killing all three of them. In a letter written prior to their deaths, the woman said that she had been suffering from depression ever since her children had been born.

    Such cases are extremely rare. Like the vast majority of mothers with postpartum depression, Cheng has never harmed herself or her baby. Nonetheless, media coverage of the condition frightens her. “Sometimes, when I’m alone with my son, I can’t stop crying,” she says in a low voice. “I would never want to hurt him, but when I think of all the pressure that his birth has put on the family, I imagine what it would be like if he had never been born.”

    Huang, the psychologist, partly attributes rising rates of postpartum depression to China’s comparatively high proportion of unplanned pregnancies. A 2009 survey estimated that up to 55 percent of mothers who themselves were born between 1980 and 1989 did not plan their pregnancies. If that figure has remained stable, then it is significantly higher than the global average of 44 percent, according to a report released in March. “Many young people get pregnant accidentally, either because they take no contraceptive measures, or because they take ineffective ones,” she says. “They’re not ready to be parents at all, and this makes it more likely that women will develop depression after birth.”

    Although Cheng had planned for the realities of motherhood, her struggle with depression took her completely by surprise. When she turned to her husband for support, she says he told her to stop whining. “He told me that I was just making a big fuss and that I should have been able to handle my emotions properly.”

    Days stretch into weeks and months, but still the pall doesn’t lift. Cheng has not approached the hospital for treatment, but hasn’t been back to the counselor, either. “Luckily my son won’t go through all this,” she whispers. “If I’d had a girl, I’d worry that she’d end up like me.”

    In China, the Beijing Suicide Research and Prevention Center can be reached for free at 800-810-1117 or 010-82951332. In the United States, the National Suicide Prevention Lifeline can be reached for free at 1-800-273-8255. A fuller list of prevention services by country can be found here.

    Editor: Matthew Walsh.

    (Header image: Wen Ruoyu/VCG)