For half a century, post-partum depression has been formally recognised as a medical condition, complete with diagnostic criteria and screening tools. Yet despite five decades of clinical recognition, profound confusion still surrounds this complex aspect of perinatal mental health.
The Limitations of Binary Diagnosis
The concept of post-partum depression first emerged in 1968, establishing a framework to validate mothers' suffering and provide specific diagnostic criteria for this life stage. Initially characterised as an atypical depression resembling anxiety disorders, its diagnosis focused heavily on symptom identification rather than comprehensive management.
This binary approach - either depression or not depression - has created significant limitations in understanding parental distress. The widely used Edinburgh Postnatal Depression Scale (EPDS), a 10-item questionnaire, concentrates primarily on maternal mood while overlooking crucial factors like parent-child bonding quality, social support systems, and identity transformation.
Thomas Delawarde-SaÏas, a psychology professor at Université du Québec à Montréal, argues this diagnostic model reduces rich, complex lived experiences to simplistic categories. In recent research published in Neuropsychiatrie de l'enfance et de l'adolescence, he and child psychiatrist Romain Dugravier propose replacing the term with 'perinatal relational distress'.
Understanding Parental Vulnerability
Becoming a parent represents one of life's most profound transitions, requiring complete emotional and practical reorganisation while caring for a totally dependent infant. For many, this experience proves deeply formative, while for others it reactivates childhood wounds around emotional deprivation, loneliness, or rejection.
Consider the case of a new mother who has always valued her independence suddenly confronting an infant's total dependence. This dynamic can trigger buried vulnerabilities from a childhood where self-reliance became essential for survival. A standard depression diagnosis fails to address this underlying tension between dependence and independence.
As Delawarde-SaÏas explains, 'Antidepressant treatment, sometimes prescribed following this diagnosis, will not address the cause of this distress. This contrasts with approaches where vulnerability is recognised and the relationship with the child can be supported.'
Towards Relationship-Centred Care
The proposed alternative draws from attachment theory, focusing on two key principles: containment and continuity. Containment involves creating spaces where parents' emotions are welcomed without judgment, helping them make sense of their experience. Continuity addresses the current fragmented care system where parents navigate multiple professionals and repeating their stories.
Current perinatal care remains divided between adult mental health services, child psychiatry, and social services, each using different languages and priorities. This leaves parents struggling to piece together coherent support during their most vulnerable period.
The researchers advocate for training healthcare teams in attachment theory, creating accessible postnatal spaces, and providing consistent support figures throughout family transitions. They emphasise that since 'there is no such thing as a baby' alone, there should be no such thing as isolated parents either.
This shift from individual disorder-focused approaches to relationship-centred care represents more than terminology changes. It acknowledges parenthood as a universal, relational human experience requiring comprehensive support beyond mere symptom management. As we mark fifty years of recognising post-partum depression, the call grows louder for mental health support that truly contains, connects, and accompanies families through this transformative journey.
