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Most parents caring for a newborn are overwhelmed and exhausted at the best of times and often can’t imagine what it would be like to be the parents of twins or more. But while up to 20 per cent of women experience a maternal mental illness during the postpartum period, according to a new study and the first study ever to explore mental health treatment needs of parents of multiples, parents of twins and triplets and beyond require more mental health support than parents of singles including tailored programs.

“In a systematic review of 27 quantitative studies on antenatal, postpartum and early parenthood mental health in parents of twins and higher-order multiples,” notes the study’s authors, “we found that mothers and fathers of multiples tend to experience heightened symptoms of depression, anxiety, and parenting stress in the postpartum and early parenthood periods.”

As a starting point for the development of future interventions, researchers of the current study, published in the Journal of Psychiatric Practice, interviewed 241 parents of multiples to get their feedback on their perceived needs, preferences, and barriers to their own mental health care. The researchers recruited parents in-person and online. Parents were then given a hard-copy questionnaire to complete either at the event they were recruited at or filled one out online.

Researchers used the Patient Health Questionnaire 9-item scale to assess symptoms of depression and the Generalized Anxiety Disorder 7-item scale to assess anxiety symptoms. They also used the Pittsburgh Sleep Quality Index to assess sleep quality, efficiency and daytime dysfunction. What they found was that the three months postpartum were the most difficult and stressful for nearly half of parents of multiples surveyed which also happens to be a critical time most lacking in support. Approximately 20 per cent of participants said that pregnancy was the most difficult time. Almost half said they would have liked mental health treatment during pregnancy and postpartum but less than 10 per cent of women said they received treatment, paralleling the statistic that less than 15 per cent of women with a postpartum mental illness generally do not receive treatment. None of the partners received treatment.

Over 60 per cent of participants weren’t asked about their mental health concerns during pregnancy. We know from research that this is likely due to lack of training among health care providers regarding perinatal mental illness and a lack of resources to help a parent once diagnosed with a mental health condition. Of those that did receive treatment, they reported that the treatment lasted approximately 10.5 months and came in the form of medication or talk therapy. Participants preferred individual and group therapy and in particular online therapy rather than medication.

“We therefore believe that technology-delivered mental health interventions may be particularly promising therapeutic approaches in this population,” note the authors, “and we recommend the development and testing of tailored eHealth intervention to increase the well-being of mothers of multiples and their partners in the perinatal period.”

Due to an increase in fertility treatments and the older age at which women have been giving birth, the rate of twin births have risen by 76 per cent in the U.S. over the past 38 years. Over the same period, the rate of triplet births have increased by 700 per cent. You read that right, 700 per cent. Researchers note that women of multiples are also at a higher risk of severe mental health symptoms.

“There is a large, unmet need for mental health treatment in parents of multiples in the perinatal period especially the early postpartum months,” noes the study. “No published studies have focused on developing or testing interventions designed to prevent or treat mental health concerns in the perinatal period that specifically target parents of multiples.”

The authors of the study write that targeted interventions are necessary for parents of multiples because they face problems such as “social isolation, increased caretaking demands and role disruption, greater medical and financial burden, and amplified sleep deprivation and interpersonal/marital stress. Some of the barriers cited by the parents surveyed include unpredictable schedules, less free time, greater time spent nursing and feeding, and more difficulty leaving the house. Symptoms were worse for unmarried couples, couples with financial problems, for couples with a baby born prematurely, and for women in general more so than her partner.

“We hope that our findings from this first study on mental health treatment needs and preferences in this population,” note researchers, “can begin to inform the development of future interventions designed specifically to address the unique mental health treatment needs of parents of multiples and women with multiple gestation pregnancies and their partners.”

REFERENCES:

Wenze, Susan, J., Battle, Cynthia, l., (May 2018), Perinatal Mental Health Treatment Needs, Preferences, and Barriers in Parents of Multiples, https://journals.lww.com/practicalpsychiatry/Fulltext/2018/05000/Perinatal_Mental_Health_Treatment_Needs,.4.aspx?PRID=JPP_PR_050418

Patricia Tomasi, (May 2018), 6 Ways Canada Is Failing Moms With Maternal Mental Illnesses, https://www.huffingtonpost.ca/2018/05/01/maternal-mental-health-canada_a_23424672/?utm_hp_ref=ca-parents