New mothers are expected to be happy, full of the joy of birth and safe delivery of their baby, yet death by suicide accounts for 10% of all maternal deaths in Australia and may be even higher from 6 weeks to a year postpartum. Home visiting programs in the United States report that over a third of mothers have clinically significant depressive symptoms and while referral to mental health services is made, lack of transport, childcare and finances often prevent access. In Australia the same issue is compounded for those living in rural and remote locations.
Why So Sad?
A study of mothers in Western Sydney from 2006 to 2016 by Dahlen et al (2018) found that those reporting intimate partner violence at their first antenatal care visit were more likely to have an Edinburgh Postnatal Depression Scale (EPDS) score above 13 and a history of anxiety, depression or both. Additionally, other studies have demonstrated the connection between family conflict as defined by non-violent expressed anger, criticism, and arguments between the mother and her family members and low cohesion, limited closeness, and support between family members as vulnerability factors for the development of depression.
What to Do?
While anxiety and depression present as ‘inside’ problems the key factors are relational and ‘outside’ the new mother. Recognising this, Cluxton-Keller et al (2025) explored the value of family therapy intervention, Resilience Enhancement Skills Training (REST) as compared to PST (Problem-Solving individual Therapy), an individual evidence-based treatment for depression, using video conferencing. While both the mother and family members participated in REST, PST was delivered individually. The hope was that those receiving REST would demonstrate a significant reduction in family conflict, improved family cohesion, reduction in maternal depressive symptoms and improvement in maternal school or work participation. If domestic violence was reported these women were deemed ineligible. 83 mothers and family members participated in the study.
What Outcomes Appeared?
Assessment was made at the conclusion of the interventions, three and six months later. While both groups returned positive benefits, ‘REST demonstrated preliminary effectiveness in reducing maternal depressive symptoms, co-occurring maternal anxiety symptom severity, and family conflict, as well as increasing family cohesion and maternal job attainment/school enrolment.’ Given the connection between family conflict and maternal depressive symptoms improving the functioning of the family by better delineation of roles and responsibilities, increasing role flexibility, addressing issues of power and hierarchy, communication and appropriate boundaries has positive benefits for both the individual and the family.
In Conclusion
It is both unsurprising and reassuring that addressing family functioning that fuels conflict has positive benefits for the mother. It is also heartening that these interventions can be offered to those in rural and remote areas who so often find services inaccessible and inflexible, putting both them and their family members at further risk. Of concern are those who report family and domestic violence. There is still work to be done.
Cluxton-Keller, F., Xie, H., Hegel, M., Donnelly, C., Bruce, M. (2025)Preliminary Effectiveness of Family Therapy for Perinatal Depressive Symptoms: Results from a Pilot Randomized Trial Family Process, 2025; 64:e70032 1 of 10 https://doi.org/10.1111/famp.70032
Dahlen HG, Munoz AM, Schmied V and Thornton C (25 April 2018) ‘The relationship between intimate partner violence reported at the first antenatal booking visit and obstetric and perinatal outcomes in an ethnically diverse group of Australian pregnant women: a population-based study over 10 years- external site opens in new window’, BMJ Open, 8(4):e019566, doi:10.1136/bmjopen-2017-019566.
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