Dec. 3, 2004. 01:00 AMPsychosis is not just `baby blues'
Twenty-seven year-old Andrea Labbe stabbed her husband and her two oldest daughters, killing one of them, before taking her own life Wednesday, police sources believe.
And there was evidence she was suffering from a severe postpartum depression illness that developed after the birth of her third child last spring.
Unlike simple baby blues which usually ends quickly or even the more serious postpartum depression which affects 13 per cent of new mothers, Labbe was probably suffering from postpartum psychosis, a serious mental illness that affects fewer than one in 1,000 mothers, experts say.
It can include schizophrenia, manic episodes, bipolar disorder, and the mother often has hallucinations, hears voices or gets delusional ideas about her baby or the world. In almost all cases, the woman needs to be hospitalized.
Normally, it appears in the first week after giving birth, said Cindy-Lee Dennis, an assistant professor in the faculty of nursing at the University of Toronto.
"If she (Labbe) had it, she probably would have had it earlier, not coming up seven months later," Dennis said, adding she finds it hard to believe no one would have known about her condition because it would be difficult to hide.
"Postpartum psychosis is a really serious condition and the woman often doesn't appear normal," she said. "There's always the possibility but it's very rare. She would not be very functional.
"It's a medical condition that needs immediate treatment. These mothers need professional help."
But a lot of women deny they have something wrong with them after giving birth, Stewart said.
"They think it's a normal part of the postpartum period or they're afraid to say things to anyone because they think their baby will be taken away," Dennis said. "They don't want to be labelled mentally ill. So women often really try hard to cover it up."
There is now good evidence that a postpartum psychosis in most cases is either a bipolar disorder that comes on after having a baby or schizophrenia that manifests itself at the time, said Dr. Donna Stewart, chair of women's health at the University Health Network and the University of Toronto.
"It is very, very difficult to mask," she said. "More commonly, everybody who knows them knows there's something really wrong here."
So how did Labbe go unnoticed and untreated?
She may have avoided seeking help out of fear or shame, said Dennis, because of the myths surrounding motherhood. "The first is the myth that motherhood is supposed to be a happy, joyous time and she doesn't want anyone to know it isn't," she said.
Also, health care workers don't always ask the right questions or respond appropriately when a woman seeks help. "Health care providers can often minimize the symptoms or tell them, `You'll get over it,' which means the woman very likely won't say anything ever again."
But health care providers are trying to get the message out to those who see new mothers, Stewart said.
Staff at the University Health Network have held information sessions with family doctors, obstetricians and pediatricians to alert them to signs of postpartum depression and psychosis, she said, and Toronto Public Health regularly holds sessions with its own nurses.
"But does everybody know about this? No," she said. "Quite often women don't want to go to their doctors, they're too lethargic. It often falls on their partners to do something. And sometimes the doctor doesn't ask."
Stewart is writing a book to alert health care workers to the symptoms of postpartum depression.
But Toronto only has three programs for women with the affliction, said Candace Roker, a social worker involved in one program at South Riverdale Community Health Centre, run jointly with Toronto Pubic Health and Toronto East General Hospital.
The other two programs are at St. Joseph's Health Centre and Women's College Hospital.
"In a city this size, I would say three programs is certainly not enough," she said.
Diane Chopping, family health manager for Toronto Public Health, said a nurse makes a follow-up call to all new mothers once they have left the hospital, often within 48 hours of discharge, as part of the Healthy Babies, Healthy Children program.
The nurse offers a home visit and does a quick phone assessment of how the mother is doing and how quickly a visit is needed, she said. Every mother is also given a phone number to call if there are any problems.
"One of the key messages we try to leave with families is `Call this number and we'll get you in touch with the help you need,'" she said. Every mother is also given a pamphlet on postpartum depression and the baby blues.
A fact sheet on postpartum depression and anxiety will also be printed in 13 languages in the new year and distributed through Health Canada.
No matter where they live, Dennis advises women to phone their local public health department which can outline the services available in their community and put them in touch with an expert. That is much easier than trying to find what they need on their own.
The healthy connections phone number for new mothers and parents of children up to the age of 6 in the city of Toronto is 416-338-7600. The number outside Toronto is in the local phone book in the blue pages under "Health."