The Absence of Symptoms Doesn’t Always Mean “Good” Mental Health
Janine, the consummate detail person, was able to get through her first prenatal visit in record time. She quickly divulged information about her health history and her experience with getting pregnant. That is, until her doctor asked her to respond to the question “In the past 7 days have you been able to laugh and see the funny side of things”…followed by “In the past 7 days have you looked forward with enjoyment to things?” The doctor had explained that these questions were part of a depression screening questionnaire that he used for all pregnant women. Janine was pretty sure that she wasn’t depressed. But on the other hand, she couldn’t say she was feeling “happy” or “content” with her life. She seemed to be in this in-between twilight zone.
Many pregnant women don’t feel emotionally healthy
In fact, while up to 25% of women experience symptoms of anxiety and/or depression during pregnancy, there is a lot of variability in the level of mental health “healthiness” among the remaining 75%.
Our research shows that as many as 30% to 40% of pregnant women have “sub-clinical” symptoms of anxiety and depression when screened. In other words, their symptoms aren’t quite severe enough to qualify as having probable anxiety or depression, but they ride under the surface and impact their lives. They feel lacking in joy, are tired and low-energy, experience a drop in their motivation, feel under stress, may not be getting what they need out of their relationships, and struggle to feel like what they’re doing in their lives has meaning and purpose.
So….while they don’t have symptoms of anxiety or depression per se, they don’t have positive mental health either.
Introducing the idea of positive mental health: Key ideas
Janine’s experience exemplifies the findings of a 2017 study by Desiree Phua, Michael Pluess and Michael Meaney (Phua et al., 2017) that explored this very topic.
It highlights 3 key points about positive mental health during pregnancy:
- It is more than the absence of symptoms of anxiety or depression
- It includes our beliefs, attitudes, and actions that are resources that we pull on when we face challenging times, such as being able to have a sense of humour and generally feeling like you are in control of your life and situations.
- It has a clear effect on the child’s development. When women had positive mental health in pregnancy, their children had significantly better cognitive and language development (based on objective laboratory testing) and better social skills.
Assessing for positive mental health
This study pulled together indicators of positive mental health from questionnaires validated and designed to screen for depression and anxiety. While there are no cut-off scores to indicate high vs low positive mental health as of yet, the higher the score, the higher the level of positive mental health.
Part A Instructions: For each of the 2 questions below, select one response.*
|In the past 7 days, I have been able to laugh and see the funny side of things*||0=not at all||1=definitely not so much now||2=not quite so much now||3=as much as I always could|
|In the past 7 days, I have looked forward with enjoyment to things*||0=hardly at all||1= definitely less than I used to||2=rather less than I used to||3=as much as I ever did|
Part B Instructions: For each of the 10 questions below, score 1=not at all; 2=somewhat; 3=moderately so; 4=very much so**
- At this moment, I feel calm
- At this moment, I feel secure
- At this moment, I feel at ease
- At this moment, I feel satisfied
- At this moment, I feel comfortable
- At this moment, I feel self-confident
- At this moment, I feel content
- At this moment, I am relaxed
- At this moment, I feel steady
- At this moment, I feel steady
Part C Instructions: For each of the 9 questions below, score 1=almost never; 2=sometimes; 3=often; 4=almost always**
- Generally, I feel pleasant
- Generally, I feel satisfied with myself
- Generally, I feel rested
- Generally, I am calm, cool and collected
- Generally, I am happy
- Generally, I feel secure
- Generally, I make decisions easily
- Generally, I am content
- Generally, I am a steady person
*From the Edinburgh Postnatal Depression Scale (validated for use in pregnancy)
**From the State-Trait Inventory (validated for use in pregnancy)
Add up the total number of points for each question (e.g., 1=definitely not so much now would equal 1 point; 2=not quite so much now would equal 2 points). This score should include all 21 questions from Part A, B and C. The higher the score, the better the level of positive mental health. There are no cut-off points as of yet indicating “high” versus “low” positive mental health.
Even though there isn’t a set “cut-off” point that distinguishes high from low positive mental health, these questions can increase our self-awareness about who we are and how our attitudes, beliefs, and approaches to life affect our mental health. Try it for yourself. I’d love to hear your thoughts in the comments below.
Phua, D. Y., Kee, Mkzl, Koh, D. X. P., Rifkin-Graboi, A., Daniels, M., Chen, H., . . . Growing Up In Singapore Towards Healthy Outcomes Study, Group. (2017). Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood: Evidence from a longitudinal study. Dev Psychopathol, 29(5), 1573-1587. doi:10.1017/S0954579417001249
Kingston, D. (2018). The Absence of Symptoms Doesn’t Always Mean “Good” Mental Health. Psych Central. Retrieved on February 22, 2018, from https://blogs.psychcentral.com/womens-mental-health/2018/01/the-absence-of-symptoms-doesnt-always-mean-good-mental-health/