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© Copyright 2000 Rogers Media. The following article first appeared in the October 2000 edition of
BENEFITS CANADA magazine.
Baby blues
Depression may strike employees when they are most vulnerable--on leave away from the support of
the workplace and juggling the demands of a new baby. It's important for plan sponsors to consider
strategies that will help nurture the mental health of new parents.
By Marta Burych
There is a striking link between mental health and productive, profitable workplaces. In fact on Oct. 10,
100 countries around the world will address Mental Health at Work, the theme of World Mental Health Day for
both 2000 and 2001.
In July, the Business and Economic Roundtable on Mental Health met to discuss the scope of the problem. RT
Capital Management Inc. president and chairman and honorary chairman of the roundtable, Michael Wilson,
says the direct and indirect costs of mental disorders equate to about 3% of Canada's gross domestic
product and 13% of the net annual profits of all Canadian companies. Depression alone costs North American
business about US$60 billion a year
Approaching employee mental health as a bottom-line issue is important, for that's where it most visibly
affects the organization as a whole. Approaching it as a pressing human resources issue is just as vital
though, for no workable solution will be found unless we understand the human dimension.
The devastating potential of this illness creates an urgent need for employers to understand and
communicate information to affected employees in a sensitive and systematic manner. For organizations that
are truly committed to employee well-being, support for the new mother- or father-to-be can't begin and end
with leave forms.
Changes to Canada's new maternity leave laws, effective Jan. 1, 2001, contribute another sense of urgency
in taking a proactive stance on this issue. With employees potentially absent from the workplace for up to
one full year, many employers are developing strategies now that will strengthen their relationship with
valued staff members over this extended period of separation.
Having the appropriate policies in place and services available will allow employers to feel confident in
helping support employees and their families through a difficult period, should the issue of postpartum
depression arise.
THE SYMPTOMS
Although a clear biological cause of postpartum depression is still unclear, enough is understood about
this mood disorder to make effective support and treatment widely available. Up to 80% of new mothers
experience baby blues--a mild depression that begins in the first days after childbirth and lasts two weeks
or less.
Physical symptoms include lack of energy, sleep and appetite, as well as food cravings and exhaustion even
after sleeping. Mental states include anxiety or excessive worry, confusion, great concern over physical
changes, nervousness, sadness and feeling overwhelmed.
Women suffering from the baby blues may find they cry more than usual, feel hyperactive and irritable, and
may have a difficult time bonding with their baby.
The symptoms of baby blues tend to dissipate in a week or two on their own, with no need for medical
intervention. Certainly, there are ways for the new mother to help herself feel better during this time.
She can:
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Be open with her partner, family and friends about how she's feeling.
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Ask for help with childcare and household needs.
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Take time away from the baby, even for an hour.
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Sleep whenever possible, and put aside the need to get unimportant things done.
If the baby blues last for more than two or three weeks and begin to have a serious impact on the mother's
ability to function, she is advised to consult her doctor or seek other professional help.
POSTPARTUM DEPRESSION
True postpartum depression affects about 10% to 15% of new mothers and tends to start later than the baby
blues, any time from three weeks to several months after birth.
Physical symptoms can include headaches, numbness, chest pains, heart palpitations and hyperventilation.
Mental states can include despondency or despair, feelings of inadequacy, inability to cope, impaired
concentration or memory, hopelessness and thoughts of suicide. Women with postpartum depression may exhibit
extreme behaviour, have panic attacks, hallucinations, extreme guilt, nightmares, feel out of control, be
hostile, have no feelings for the baby or be overly concerned for the baby.
Research on postpartum depression and the baby blues--as well as a third rare categorization, postpartum
psychosis--offers many factors as potential causes and risks, but few definitive answers. Studies point to
hormonal shifts, maternal age and birth order, psychiatric history and marital relationships as possible
causes.
Obsessive-compulsive disorder, severe sleep disturbances and anxiety may be predictors of postpartum
depression, and a strong relationship has been established between self-esteem and depression. Other
possible factors cited are early discharge from hospital, mode of delivery, stress levels and the existence
of a support network.
FIRST STEPS
Many women who suffer from postpartum depression do not realize they have the illness, which compounds the
problem. Their symptoms can magnify the isolation, vulnerability and sense of inadequacy sometimes
associated with parenting an infant.
The new mother may distance herself from her family, friends and healthcare professionals at a time when
she needs help. This is why it is important for a new mother, her family, her employer and those in her
support network to be aware of the possibility of postpartum depression.
Taking care to monitor moods and emotions can avoid the danger of escalation. Postpartum depression is
easily treatable, so the earlier help is received, the better.
After recognizing or even suspecting there may be a problem, the first step in the successful treatment of
postpartum depression is contacting a professional--whether it's an obstetrician/gynecologist, family
doctor, pediatrician, counsellor or psychiatrist.
It's important for the woman to be candid about how she's feeling, which, depending on the scope of the
illness, may be difficult. But support in this area is imperative.
The woman may not have the emotional strength to seek appropriate professional help at this time and may
need friends or family to step in. Once a diagnosis is made, appropriate treatment can begin. This may be
medication, counselling or a combination of both. Group or individual therapy can be invaluable for both
the mother and father when facing the many challenges of parenting, including those related to postpartum
depression.
EMPLOYER'S ROLE
As with any factor affecting the mental health of employees, postpartum depression can have far-reaching
effects on the workplace. The employer's role in preventing this illness may be limited, but it can be
invaluable in managing it.
Depending on the employee's support network and level of awareness, the employer may well provide the first
critical introduction to this potentially devastating illness, whether it's before a leave or during one.
Whether the employee is a new mother or a new father, the employer has a responsibility to communicate a
clear and timely message: Postpartum depression is a reality that may affect you and/or your partner. As
your employer, we're prepared to help.
Sending a fact sheet about postpartum depression via interoffice mail to a pregnant female employee may
serve the purpose of introducing her to the illness. It may also send an inappropriate message about the
employer's values.
A progressive, caring employer will take the time to build a communication plan around this subject, taking
responsibility for doing as much as possible to prevent postpartum depression from negatively impacting
employees and their families.
DEVELOPING A PLAN
For employers with an employee assistance plan in place, knowing that counselling and other services are
just a phone call away can provide comfort to the employees who need help--as well as to employers who want
to help. But having these services at one's disposal can be a temptation for employers to assume that no
further action is required.
In the few months before maternity, paternity or parental leave, the employer should take advantage of the
opportunity to review with employees the range of services that relate to pregnancy, childcare, family
matters and mental health that the organization covers through its benefits plan, as well as those services
that are available in the community.
Timing of all communication--in person, on paper, electronic or otherwise--is crucial. The employer must be
as sensitive as possible though about how and when the delicate subject of postpartum depression is
broached.
FINE LINE
The safest way to ensure the subject is handled appropriately is to consider all possibilities when
developing a communications plan that builds awareness of this illness into present policies.
Representation from various departments, specifically health and safety, communications and human
resources, will provide a broad range of skills and experience and help formulate the best approach.
Another caution concerns the fine line between support and interference. As mentioned earlier, the
employer's role in promoting health and wellness is limited. And for good reason.
No matter how extensively personal lives impact the workplace, they are private. The employer can educate,
offer services of support and make every effort to champion its employees. The employer cannot, however,
step over the line.
CLEAR COMMUNICATIONS
A clear plan and well-communicated policies help define this line for everyone concerned. If the plan
includes a call from the company nurse to the employee every two months during the maternity leave, then
this should be communicated to the employee before the leave begins. The employee may not want that level
of involvement. Or she may welcome it.
If the plan involves providing the employee with a list of community resources to deal with postpartum
depression, it's important to establish how and when that will information will be delivered. The plan
sponsor also needs to determine if they will make concessions for a new father to take time off to support
his partner suffering from postpartum depression.
Employers should also ask if their communication plan provides specific guidance for dealing with a
personal crisis that occurs when an employee is on leave.
How an employer communicates information about postpartum depression to its employees depends a great deal
on the culture of the organization.
It may be out of character for an employer to start showing interest in a pregnant worker or a father-to-be
around this issue, when support and communication has been scarce in the past. At worse, it could be deemed
inappropriate. On the other hand, it could be the first sign of positive change.
Marta Burych, M.S.W., is a counselling supervisor at Warren Shepell Consultants in Toronto.
mburych@warrensheppell.com.
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Taking Action
Helping employees adjust to a new baby while optimizing their mental health.
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Don't allow untrained employees to offer counselling.
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Do have professional counselling in place.
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Do have a childcare consulting service in place.
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Don't haphazardly distribute material on mental health issues to employees.
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Do establish a company team to spearhead new policies and practices regarding the illness.
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Do review counselling services--be it an employee assistance program or coverage for visits to a
licensed professional--with staff before their leave.
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Do consider making the following available for employees with growing families:
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New parent kit.
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Workshops on family issues.
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Up-to-date list of community resources.
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Fact sheets on health issues.
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Do consider a review of policies and procedures to ensure that promoting employee mental health is a
priority in your workplace.
When the employee is a father-to-be:
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Do incorporate postpartum depression information into support services for fathers-to-be.
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Do review services for employee's own needs, as well as their partner's.
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Do encourage male employees to notify human resources when their partner is pregnant.
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Don't be insensitive to the increased demands and decreased energy of the new father.
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Risk factors for postpartum depression
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Marital problems.
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Depression or anxiety during pregnancy.
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Poor support from spouse, parents, in-laws, employer and/or friends.
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Stress or negative life events.
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Previous postpartum depression or other mood disorder.
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History of severe pre-menstrual syndrome.
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