Loneliness was found to be a key factor in the development of perinatal depression among women, especially those in marginalized communities, according to study results published in BMC Psychiatry.
Investigators from Universities in the United Kingdom searched publication databases from inception through to July 2021 for studies about loneliness in the perinatal setting for this meta-synthesis. A total of 27 articles were included.
The studies were published between 1992 and 2021 and most were conducted in North America (n=11) or the UK (n=10). Two-fifths of studies (41%) focused on marginalized groups, such as immigrants, ethnic minorities, and teenage mothers. The pooled sample size was more than 537 and the women and girls had a mean age of 27.7 (range, 15-49) years.
A total of 8 overarching meta-themes and 3 subthemes were identified in the thematic analysis.
The overarching themes were: self-isolation and loneliness due to societal stigma, a sense of emotional disconnection from depression fuels loneliness, a mismatch between expected and observed support leads to loneliness, validation from health care professionals, peer support from other mothers who have experienced perinatal depression, practical and emotional support from family, a lack of professional support, and conflict and separation from partners or family.
Many women expressed they had fears of being judged for being a “bad mother” or “bad wife” and felt an expectation to be happy in their new role as a mother. Women reported criticism, rejection, or discrimination from their partners, family, friends, health care professionals, colleagues, and themselves.
Many women said they were told to “snap out of it.”
Stigma appeared to be particularly acute among marginalized groups. In which their already marginalized status was compounded by new motherhood.
The fear of negative judgement often led women to self-isolate which tended to exacerbate feelings of loneliness. Some reported avoiding help-seeking even if they recognized their need for help. In some cases, this reluctance to seek help stemmed from a fear of social services becoming involved or removing their child from their care.
The role that loneliness played in feelings of depression was not always clear. Some women with good support networks reported an inability to emotionally connect with others around them or their baby, leading to feelings of loneliness. Other women felt lonely due to feelings of being misunderstood or feeling like a “fraud.”
Loneliness was improved by validation from trusted health care professionals, peers, and family. Positive outcomes were reported when professionals or peers listened to and reassured the women that they weren’t “bad mothers” or when a family member took the baby, so they had some alone time.
Loneliness was made worse by a lack of support or conflicts with partners or family. When women felt unwelcome to share their feelings or when partners or family did not support them, they reported greater feelings of loneliness.
Study authors concluded, “The results provide a solid foundation for further theories about the role of loneliness in perinatal depression. They also provide evidence on which the development of future psychological and social interventions could be based, to address the stigma faced by women experiencing perinatal depression and to offer [personalized] and culturally appropriate support that might reduce the risk of both loneliness and depression.”
Adlington K, Vasquez C, Pearce E, et al. ‘Just snap out of it’ – the experience of loneliness in women with perinatal depression: a meta‑synthesis of qualitative studies. BMC Psychiatry. 2023;23(1):110. doi:10.1186/s12888-023-04532-2