Post-adoption depression (PAD) and Post-adoption Anxiety (PAA) are a reality more common than many might assume. Despite its prevalence, it remains a difficult topic for adoptive parents to discuss. Ignoring post-adoption anxiety and depression can result in prolonged struggles for both parent and child.
Cause and Prevalence
Although adoptive parents do not experience many of the risk factors for depression or anxiety in biological mothers, such as hormonal changes or delivery complications, adoptive parents experience the same challenges that any new parent faces, including increased levels of stress, lack of sleep, exhaustion, and alterations in relationships. Adoptive parents also have to contend with establishing an emotional relationship with their child, who has encountered trauma and may not have had a stable, positive experience of family life. Adopted children may also struggle to adapt to their new family structure and often struggle with behavioral dysregulation. Factors such as financial hardship, the anticipation of bringing the child home, and lack of control in multiple aspects such as prenatal care, and quality of life before the adoption. There are also unmet expectations, bonding difficulties, and often unexpected grief. Having conflicting feelings such as grief and gratitude, hope and disappointment, or joy and loss can be triggering. Recent studies suggest that approximately 11% to 12% of adoptive parents experience depressive symptoms whereas 10% to 17% experience anxiety symptoms. Caring for a child with special needs such as medical or psychiatric conditions or babies requiring a NICU stay increases the risk of depression and anxiety. Depression and anxiety can have negative repercussions for the child.
Symptoms and Manifestations
The symptoms of PAD mirror those of general depression, including a persistent low mood, loss of interest in daily activities, changes in appetite and sleep patterns, and feelings of worthlessness or guilt. The symptoms of PAA include a sense of dread or danger, racing thoughts, feeling on edge, excessive worry, an overwhelming sense of burden or stress, feeling agitated, insomnia, undereating, or overeating. Anxiety can manifest as physical symptoms such as fast heartbeat, shortness of breath, or chest pain. Some parents describe feeling like "bad parents”, feeling inadequate, questioning their competency, or experiencing panic over their adoption decision. Symptoms of anxiety and depression may develop gradually.
Addressing PAD: Strategies and Tips
Mental Health Check Before Placement: It's crucial for prospective parents to assess their mental health and readiness for adoption. Identifying personal and professional support networks can provide a safety net if symptoms emerge.
Surround Yourself with Competent Support: Adoption-competent professionals who understand the unique challenges of adoption can offer invaluable support. They can help parents navigate their own emotions and better understand their child's needs.
Reframe Expectations: Unrealistic expectations of oneself, your partner, the child, and the adoption process can contribute to depression and anxiety. Reframing these expectations can help parents manage their emotions more effectively.
Normalize Post-adoption Support: Just as new biological parents receive postpartum support; adoptive parents should have access to services. Emotional and practical support can mitigate the impact. Family and friends can help with laundry, meals, cleaning, caring for with older children, and running errands
Seek Help Without Shame: Stigma around mental health can prevent parents from seeking the help they need. Therapy can offer a supportive environment where parents feel safe to express their struggles and has been proven to be effective. Psychotropic medication is also used to treat postpartum depression and anxiety.
While post-adoption depression and anxiety are not often discussed, it's clear that preparation, support, and open dialogue are key to managing it. By understanding and addressing PAD/PAA, we can support adoptive families in building strong, healthy relationships and ensuring the well-being of both parents and children. Parents experiencing depression and anxiety deserve compassion, understanding, and access to resources that can help them navigate this challenging but rewarding journey. If you are struggling with post-adoption depression or anxiety, reach out to the Moms Mental Health Initiative for support.
References:
Anthony, R. E., Paine, A. L., & Shelton, K. H. (2019). Depression and anxiety symptoms of British adoptive parents: A prospective four-wave longitudinal study. International Journal of Environmental Research and Public Health, 16(24), 5053. https://doi.org/10.3390/ijerph16245153
Dean, C., Dean, N. R., White, A., & Liu, W. Z. (1995). An adoption study comparing the prevalence of psychiatric illness in women who have adoptive and natural children compared with women who have adoptive children only. Journal of Affective Disorders, 34(1), 55-60.
Foli, K. J., South, S. C., Lim, E., & Jarnecke, A. M. (2016). Post-adoption depression: Parental classes of depressive symptoms across time. Journal of affective disorders, 200, 293–302. https://doi.org/10.1016/j.jad.2016.01.049
Senecky, Y., Hanoch, A., Inbar, D., Horesh, N., Diamond, G., Bergman, Y. S., & Apter, A. (2009). Post-adoption depression among adoptive mothers. Journal of Affective Disorders, 115, 62-68.
McKay, K., Ross, L. E., & Goldberg, A. E. (2010). Adaptation to parenthood during the post-adoption period: A review of the literature. Adoption Quarterly, 13(2), 125-144.
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