Postpartum depression more common in urban areas

Women living in urban centres in Canada with more than 500,000 inhabitants are at higher risk of postpartum depression than women in other areas, suggests a new study in the Canadian Medical Association Journal.

Looking at the experiences of over 6,000 women who lived in rural, semi-rural, semi-urban or urban areas from the 2006 Canadian Maternity Experiences Survey, the study suggests that women in urban areas were at higher risk, with almost 10 per cent reporting postpartum depression compared with six per cent of women in rural areas, almost seven per cent of women in semirural areas and about five per cent in semiurban areas.

Urban areas were found to have higher numbers of immigrant populations, and more women in these areas reported lower levels of social support during and after pregnancy. 

"We found that Canadian women who lived in large urban areas … were at higher risk of postpartum depression than women living in other areas," said Dr. Simone Vigod, psychiatrist at Women's College Hospital and scientist at Women's College Research Institute in Toronto.

"The risk factors for postpartum depression [including history of depression, social support and immigration status] that were unequally distributed across geographic regions accounted for most of the variance in the rates of postpartum depression."

The reason why immigrant woman appear to be at higher risk is not really known, she said. "Some theories are that it's related to social support or being away from their family."

They could also have cultural barriers or needs that are not being met, she added.

In Canada, about 20 per cent of people live in rural or remote regions, 35 per cent live in the large urban areas of Montreal, Toronto and Vancouver, with the remaining 45 per cent in semirural or semiurban areas. 

The survey defined rural as people living in settlements smaller than 1,000 people or with 400 or less inhabitants per square kilometre; semirural (under 30,000), semiurban (30,000–499,999) and urban (500,000 and over).

Overcoming depression

Andrea Page, a mother and fitness coach in Toronto, who suffered postpartum depression to the point of becoming suicidal, told CBC News that the common perception of motherhood being instinctive for every woman doesn't make sense. 

"The idea that a mother is the be all and end all as the source of energy for a child in this culture is silly. It just doesn't add up," she said. "No one person can fulfil this role."

Having had many of the risk factors associated with postpartum depression, including being a single mother (during her first baby), and difficulty breast-feeding, Page said she was often told by people that she should feel content.

"My best friend told me I should just have been so happy because I had a brand new baby," she recalled. "I told her it's not that I'm not happy about it but I'm just not happy trying to function in this same scenario. 

"I'm alone all the time talking to a three-month old ... he doesn't talk back. I don't feel like I'm doing a good job at anything. What outside of me is feeding me positive information about myself? Not much."

Eventually Page reached a point where she felt the will to push herself back up. Being physically active before getting pregnant, she began exercising at home with her baby.

"It gave me some focus and something to feel good about," she said. "I had something tangible outside myself that I was doing that was making me feel like I'm a worthwhile human being."