Summary: New research highlights that anger is a prominent feature of postnatal mood disturbance. Authors recommend screening for anger alongside depression and anxiety during the postpartum period.
Source: University of British Columbia.
Health professionals should screen postpartum women for anger as well as depression and anxiety, according to new findings from the University of British Columbia.
Although anger has been observed in some women experiencing postnatal mood problems, it has received little focused study and is not included in widely used screening tools such as the Edinburgh Postnatal Depression Scale. In an integrative review of existing literature, UBC nursing PhD student Christine Ou identified anger as a meaningful and sometimes severe component of postnatal mood disturbances.
“Researchers have paid a lot of attention to postpartum depression and anxiety, but anger has largely been overlooked,” Ou said. “Evidence suggests that when anger co-occurs with depression it can intensify symptoms and prolong recovery. That combination can adversely affect the mother’s mental health, the parent–child relationship, and family dynamics.”
Ou’s review, published in the journal Birth, found that anger in the postnatal period often stems from feelings of powerlessness, a mismatch between expectations and reality of motherhood, and frustration about unmet support needs.
“Anger often appears as a reaction to shattered expectations about motherhood,” Ou explained. “Mothers may feel they have failed to live up to their own ideals or worry about being judged for choices such as formula feeding instead of breastfeeding. Many women describe feeling let down by partners, family members or health-care providers when support doesn’t match needs.”
Ou also pointed out that cultural norms often discourage women from expressing anger, which likely contributes to the lack of research and clinical attention devoted to postnatal anger. Because anger can be stigmatized or suppressed, mothers may not report it unless specifically asked.
“Some theorists suggest that anger can arise from adverse circumstances, and if those circumstances do not change, anger may give way to depression,” Ou said. “In the postnatal context it isn’t always clear whether anger precedes depression or emerges alongside it, but both scenarios indicate the need for clinicians to assess for anger as well as depressive symptoms.”
Wendy Hall, UBC nursing professor and Ou’s thesis supervisor, emphasized the clinical implications of the findings. “Children exposed to parental anger or depression face a higher risk of emotional and behavioral difficulties,” Hall said. “Recognizing and addressing maternal anger during the postpartum period is important for reducing these risks and supporting healthy family relationships.”
Source: University of British Columbia
Publisher: Organized by NeuroscienceNews.com
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Original Research: Christine H. Ou RN, MSN and Wendy A. Hall RN, PhD. “Anger in the context of postnatal depression: An integrative review.” Birth. Published May 20, 2018.
DOI: 10.1111/birt.12356
• Anger is a notable but under-recognized element of some postnatal mood disorders.
• Anger can coexist with depression and may intensify symptoms and prolong recovery.
• Sources of postnatal anger include feelings of powerlessness, violated expectations about motherhood, and inadequate support from partners, family or health services.
• Cultural norms that discourage expressions of anger, particularly among women, may contribute to underreporting and under-researching this issue.
• Clinicians and researchers should include assessment of anger when screening for postpartum mood disturbances to better identify at-risk mothers and improve outcomes for families.
Abstract
Anger in the context of postnatal depression: An integrative review
Background
Contrary to social portrayals of new motherhood as universally joyful, some mothers experience postnatal depression and anger. While postnatal depression has been widely studied, the role and expression of maternal anger in this context remain conceptually unclear. This integrative review examined how anger is framed and reported in relation to postnatal depression.
Methods
The review searched multiple databases and identified qualitative (n = 7) and quantitative (n = 17) studies that addressed maternal anger and postnatal depression. The authors synthesized findings and developed thematic categories.
Results
Anger emerged as a salient mood disturbance for a subset of postnatally depressed women. Three integrated themes were identified: (1) anger that accompanies depression, (2) powerlessness experienced alongside both depression and anger, and (3) anger arising from violated expectations about motherhood.
Conclusions
The review indicates that anger can coexist with postnatal depression and may be directed toward the self, children or family members, with potential negative impacts on relationships. The authors recommend that healthcare providers and researchers include anger in assessments of postnatal mood disturbances to better understand and manage associated risks.