Sunday, September 16, 2012
More About Post Adoption Depression
Some recent correspondence I’ve had with an adoptive mother has made me more concerned than ever about the possibility of depression following adoption and its potential impact on the adoptive family as a whole, as well as on the developing adopted child. My correspondent describes her experience with depression as “a living hell” with “three monsters” and states that “I did things then that I would never even consider doing now” (following treatment). She sent the children to her mother’s house because she knew they were not safe at home; she reports that “most of my thoughts were about being overwhelmed, running away, and wanting to die”.
When I searched Academic Search Complete for material on Post Adoption Depression, I was interested to see that many of the papers that came up were on depression in adopted children rather than in adoptive parents. It was over 15 years ago that the term Post Adoption Depression was first used, but a clear description and explanation of the phenomenon are still very much in the works. The common belief that hormonal changes cause post-partum mood disorders made it—and still makes it-- difficult for many people to accept that a post-adoption problem can also exist. A 1999 paper (Gair, S.. Distress and depression in new motherhood: Research with adoptive mothers highlights contributing factors. Child and Family Social Work, 4, 55-66) reported that about 30% of the adoptive mothers studied scored high on a questionnaire used in assessment of depression. A number of the mothers spontaneously stated that what they had was “post-natal depression”. Interestingly, Gair noted that “Typically, in Western society, the source of discontent in mothering is not seen to have its origins in the tasks of caring and mothering… Rather the fault is seen to lie with individual mothers”-- a belief that minimizes the actual stress of caring for children and may be a cause for depression when new mothers discover how demanding these tasks actually are. As Gair pointed out, this would be intensified by the lack of social support more common in adoption than in pregnancy and childbirth. Gair summarized the evidence that hormonal factors are not a major cause of post-partum depression and argued that the events that cause depression are similar in both birth mothers and adoptive mothers.
More recently (Payne et al., . Post adoption depression. Archives of Women’s Health, 13, 147-151), researchers concluded that “Significant depression symptoms were relatively common [about 30% of the group] in adoptive mothers within the first year after adoption and were associated with environmental stress”. Most of the mothers in this study had adopted because of infertility, a condition associated with painful and intrusive treatment and with a sense of shame and loss of self-esteem, possibly making them more vulnerable to the effects of later environmental stress (my statement, not Payne’s—J.M.). In another recent study (Foli, K., & Gibson, G.C.  . Sad adoptive dads: Paternal depression in the post-adoptive period. International Journal of Men’s Health, 10, 153-162.), the researchers described the occurrence of depression—often expressed as anger-- in adoptive fathers, possibly in response to their wives’ depression.
As for the impact of parental depression on children, there has been an examination of this issue focused on adopted children (Natsuaki, M.N., et al. . Genetic liability, environment, and the development of fussiness in toddlers: The roles of maternal depression and parental responsiveness. Developmental Psychology, 46, 1147-1158). The concern of this study was of the role caregivers’ responsiveness can play in helping infants grow into toddlerhood with less negative emotion than they might otherwise show. Parents who were responsive to their 9-month-old babies’ signals were shown to have less irritable toddlers when the children were 18 months old. One major effect of depression is to reduce the adult’s responsiveness to child communications, especially when the signals are hard to understand, so depression is likely to be linked to unresponsiveness and later to child fussiness. This and much other evidence points to parental depression as playing an important role in children’s development-- treatment of depression is not just for the comfort of the adult, but for the development (and even the safety) of the child.
Unfortunately, as an article by Foli and Gibson has pointed out (2011; Training “adoption smart” professionals. Journal of Psychiatric and Mental Health Nursing, 18, 463-467), not only is there relatively little research on Post Adoption Depression (and that research has a number of problems that I haven’t mentioned here), but adoption caseworkers do not have much awareness of what is known on the subject, and adoptive parents receive little or no training about it.
I want to voice a particular concern about untreated depression in adoptive parents. I must ask, to what extent does depression create vulnerability to inaccurate statements about adoption-- for example, that even children adopted at birth are grieving for their birth mothers? To what extent does depression make adoptive parents ready to accept stern, repressive, even dangerous regimens claimed to “cure” their children? Does thinking about harming your children (as an aspect of depression) make you more likely to let someone else hurt or endanger them? I once came across a description of “holding therapy” as what parents can choose when they want someone else to hurt their child for them. Do unconventional treatments like “holding therapy” exploit the undiagnosed and untreated depressions of some adoptive parents? I don’t know the answers, but I believe this topic is one that needs much further exploration.