The Consumer with Depression (Peripartum onset): Marie
Clinician Role: Admitting Nurse: Inpatient Mother and Baby Unit.
Identifying information: Marie is a 31-year-old married woman referred to the Inpatient Mother and Baby Unit by her GP. She is a practising Catholic and has worked as a secretary for 9 years at a local private school as the office manager. Marie lives with her husband, Ron, and their 10-week-old daughter, Nicole, in their own home.
Presenting Complaint: Marie states, “I’m not coping at all with the baby; I’m sad and upset all the time, and I’m a bad mother”.
History of Present Problem: Marie states that over the past 10 weeks (since the birth of Nicole), she has experienced increasing dysphoria, anhedonia, feelings of guilt and worthlessness, intense crying, social isolation, and has struggled to bond / care for her daughter.
Marie sleeps 10 to 15 hours per night, experiencing no difficulty falling asleep or middle-of-the-night or early-morning awakening. Her appetite has diminished during the past 2 months, with a reported weight loss of 8 kilograms. She eats erratically, usually snacks, and meals are prepared by her husband and mother. She has not been able to provide effective care to her daughter, cook, or do household chores and generally spends the day in bed. She has had become increasingly insular and has avoided social contact, tending to avoid friends and family who have come to call: she has not attended the Mothers group meetings that her MCH nurse had linked her into. Marie describes no interests or involvements outside the home, except for weekly attendance at Church. Her husband and mother have assumed the primary care for Nicole however with her husband due to return to work in 2/52 this is becoming a concern for the family.
Mornings are the most difficult for Marie — she feels increased anxiety, has difficulty breathing, and cries a lot. She describes feeling disconnected from Nicole and describes increased guilt and a sense of being a ‘failure’ as a mother. She admits to occasional suicidal ideation in the form of a passive wish to be dead in hopes of relieving her emotional pain. She denies a history of suicide attempts or current suicidal plan. She denies alcohol or drug abuse.
Current life stressors reported by Marie include:
· Her brother’s death in a car accident 6 months ago. Marie had not seen him in 1.5 years and expresses guilt that they were not close.
· Her sister’s surgery for cancer 5 months earlier. Whilst she has made a good recovery Marie is fearful that she will die in the near future.
· The transition to parenthood and caring for Nicole. Marie and Ron had been planning for their first child for some time and had been very excited about the impending change in their lives. Her pregnancy and birth had gone well though she had struggled to breastfeed, eventually giving up after 5 weeks of trying. Marie feels very guilty about this and thinks she should have tried harder.
· Loss of her sense of role / structure she had gained from her job. Marie had been in her role for many years, was well like and respected and was very committed to the job. She stopped work when 32 weeks pregnant and has struggle to organise her time since then.
Past Psychiatric History: Marie has had no prior hospitalisation or community psychiatric treatment. She denies previous episodes of depression. There is no history of mania or hypomania.
Pre-morbid Personality: Marie describes herself as being hard-working, kind, well organised and committed to her job before becoming unwell. When asked further about work she says she was very hard-working, motivated to do well at work, able to pal and organised complex tasks and shows pride in her ability to see jobs through to a successful completion. She also reports a strong sense of loyalty to family and close friends, willing to go out of her way to help others.
Medical History: Marie’s only physical ailment is borderline hypertension, with a significant family history of same [though it is not treated by medication].
Family History: Marie’s father died from a myocardial infarction at the age of 52, 10 years ago. Marie’s brother, who died 6 months ago in a MCA, was 28 years old. Her sister is 37 years old and is divorced with two daughters, ages 7 and 9; she was recently diagnosed with cervical cancer though is in remission at present. Marie believes her maternal grandmother was depressed but knows no details about this.
Social and Developmental History: Marie is the middle child of three siblings. Her mother’s labour and delivery with her were normal, and developmental milestones (talking, walking, etc.) were reached at an early age. She denies any maladaptive behaviours or experiencing unusual stresses as a child. Academically, Marie was an A student throughout her educational experience. She had friends at school and in the community and did not date until after high school. She completed a 3 year business degree. Marie has work in an administration role with the same organisation since graduation, and she has worked her way up to office manager.
Marie was raised in rural Victoria and lived there until she was 22, at which time she moved to Melbourne to marry Ron. They initially focused on establishing their careers and buying a house before deciding to try for a baby approximately 18 months ago. Marie describes her 9-year marriage as good but states they both take it for granted at times. She and Ron were very excited about becoming a ‘family’.
Marie is a practising Catholic, attending weekly mass and occasional confession. Despite her husband’s encouragement, she does not attend Church social groups or participate in any other outside activity.