City Weekend

Amid the joy of motherhood: the forgotten Hong Kong women left behind by crushing depression

About one in 10 new mums in Hong Kong struggle with postnatal depression, as families wrestle with finances, new roles, and the city’s cramped and competitive lifestyle. With all eyes on the baby, don’t forget about Mum, psychiatrists say

PUBLISHED : Saturday, 25 August, 2018, 8:01am
UPDATED : Saturday, 25 August, 2018, 3:26pm

When Vivian Lee gave birth to her first child, family and friends were overjoyed, and for days the congratulations came pouring in.

Nobody ever noticed how much the new mother dreaded their cooing and delight at her new baby boy.

“Whenever friends and relatives came over, I felt neglected because they would keep asking how the baby was doing,” the 28-year-old former designer recalls of that dark period in 2017.

“But what about me? I kept asking myself, why aren’t they concerned about whether I’m well?”

She was overcome by anxiety, and in the months that followed she struggled to adjust to her new role as a full-time mother.

Lee, whose son Preston is now 1½ years old, was experiencing postnatal depression, a serious mood disorder that affects some women after childbirth.

About one in 10 new mums in Hong Kong struggle with the condition, and the prevalence rate worldwide is between 13 and 19 per cent, according to the city’s Centre for Health Protection.

But the local figure is likely to be an underestimation as most people remain unaware postnatal depression exists.

New mothers are expected to focus on the needs of their newborn rather than their own emotional issues, but the condition can develop up to a year after a baby is born.

Childbirth for most couples is a happy time, and men are often clueless as their wives slide into depression after the infant arrives.

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In July, a mother jumped to her death after throwing her two-year-old toddler out of the window of a flat at a public housing estate in Yau Tong. After looking into her medical records, police believed she had suffered from postnatal depression. While the 35-year-old mother died, her boy was reported to have survived the fall, and police said he was fighting for his life.

For Lee, being pregnant also proved stressful. She had to leave her job after her employer learned about her pregnancy. Her husband is a marketing manager.

Describing the crippling anxiety she felt after she found out she was expecting, the now blogger says she suffered from both perinatal depression and postnatal depression, bringing her countless sleepless nights worrying about her ability to raise her son, physically and financially.

“I had to leave my job when I told them I was expecting, and that left me utterly shattered,” she says.

Then came the loss of appetite and poor concentration, which got worse after the baby came.

“At a point, I worried my husband would develop depression as well,” she recalls. “He has been very supportive since he found out I had the disorder, and has been bearing all the burden of the family.”

She counts herself lucky for being able to receive help in time, only because she opened up about her emotions to her doctor, who soon referred her to seek help.

“I would never have guessed in a million years that I was mentally ill,” she says.

Lee was put on an antidepressant and went to counselling once a month. It took her a year to finally recover.

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Last year, 56,500 babies were born in Hong Kong – the lowest number in a decade. The birth rate was 7.7 per 1,000 people, which was among the lowest in the world.

It compares with 8 in Japan, 9 in Singapore, and 12 in mainland China, Britain and the United States. Based on the average number of births per woman, the fertility rate for Hong Kong last year was 1.19, exceeding 0.83 in Singapore, but lower than 1.41 in Japan, 1.87 in the US and 1.88 in Britain, according to data from the CIA.

Having a baby ought to be a happy experience, but psychiatrists point out that it is a stressful period for parents in Hong Kong’s competitive, fast-paced culture.

It is also costly to raise the child, especially in a city rated one of the world’s most expensive places to live. The competitive education culture has created a desire among parents to help their children “win at the starting line” by making them accomplish as much as possible early.

The cost of a child from birth to college graduation in Hong Kong averages about HK$5.5 million (US$700,600) for a middle-class family, according to calculations by think tank the Bauhinia Foundation Research Centre.

On top of the expense, the limited living space in the city is a problem. The median floor area of accommodation is about 430 sq ft, and the median per capita floor area about 161 sq ft, according to government data.

Competitive pressures also come into play. It is common for Hong Kong parents to sign up babies as young as six months old for popular playgroups, in order to increase their chances in the race for a place in their preferred kindergarten and primary school.

Adele battled postnatal depression before and after son’s birth

All of this puts off many young couples from having babies at all.

Lee says of having a child: “It really takes a lot of courage in a city like Hong Kong. We always want the best for our children.”

Psychiatrist Gregory Mak Kai-lok says that like Lee, many local parents battle with intense stress through pregnancy and childbirth, not least because of housing problems and the heavy financial burden.

Couples have to squeeze into their already cramped homes a whole host of new items, including a crib and stroller.

It takes a toll if couples live with either of their parents – a common practice in Hong Kong.

“There may be the power struggle over how to raise the child, and conflicts with the in-laws about who will look after the baby when the parents are off at work,” Mak says.

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It affects the fathers, too

Ming, a first-time father in his 30s, was feeling teary and emotional after his wife gave birth to their newborn.

That’s when he realised mums aren’t the only ones who suffer from mental illness.

Ming had no one to tell, and could not understand how the joyous occasion had become the source of his misery.

As he described his condition to his psychiatrist, Dr Rachel Cheng Shuk-yee, inside her office in Central, she knew exactly what he was going through – postnatal depression.

“Becoming a father is a big deal, it comes with new responsibilities, roles and pressure. And when the expectation of life with their newborn does not match the reality, it becomes stressful,” Cheng explains.

“Men are less likely to express their feelings, and the lack of attention causes them to bottle up things such as low self-esteem, hopelessness and constant irritability.”

New research by the American Psychological Association reveals that roughly 10 per cent of new dads experience depression, and up to 18 per cent endure some type of anxiety disorder.

Although equivalent figures for Hong Kong are not available from the Department of Health, one study estimates about 5 per cent of local fathers are affected by emotional disorders. Published in the Hong Kong Medical Journal in 2011, the survey found fathers feeling overwhelmed, anxious, and experiencing self-blame and guilt about their perceived inabilities to look after their new baby.

That was the case for Ming.

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Having to juggle work and the change in lifestyle, an onslaught of negative emotions came rushing at him.

His efforts to attend to the baby were often dismissed and criticised by his wife.

He was unhappy over his inability to soothe his crying baby, and at the same time was unable to connect emotionally with his wife. All these factors had pushed him over the edge.

“As fathers are trying to attend to their children, they are also trying to balance that with being the household provider and caring for their wives. In the process, they get burnout,” Cheng says.

The depleted mental status not only affects the marriage but also snowballs and ends up impacting the health of the children, Cheng says, citing a JAMA Psychiatry research report from last year.

Maternal depression can have a long-term effect on daughters, and a father’s mental health condition can significantly increase his sons’ risk of developing mental and behavioural issues such as hyperactivity, disorderly conduct or suicidal thoughts.

“If the fathers are found to have persistent and severe postnatal depression, then their sons are 1.91 times more likely to suffer from mental health problems when they’re 18 than their teenage friends whose fathers did not have the disorder,” Cheng says. The reasons are unknown.

As a mother who has recovered, Lee is now very keen to raise awareness in Hong Kong of postnatal depression.

Talking about mental illness helped mum understand her depression and unify our family. How to start that conversation

The condition is currently often detected from a survey given to mothers at Maternal and Child Health Centres, but Lee believes this is not sufficient, and says a more proactive approach is needed.

“[The survey] asks if the mother has these symptoms, but [the centre] rarely takes action to reach out to parents to make sure they’re mentally OK,” Lee says.

Psychiatrist Mak adds that while it is normal for new mothers to experience hormone disturbances and the resulting emotional fluctuations, the seriousness of it is often overlooked.

“There’s a difference between postnatal blues and postnatal depression. We must not dismiss the signs and take them lightly,” he says, emphasising that prevention is always better than cure.

In Australia and Britain, the care systems do not just focus on the baby. They also provide mental health care for parents, Mak says. He urges Hong Kong to adopt the same approach.

Experts and parents agree that extending paternity leave would help the situation.

Hong Kong mothers enjoy absences of 10 weeks, but fathers only three days, and even those come with conditions.

The average length of paternity leave in the European Union is 1.4 weeks, according to the Organisation for Economic Cooperation and Development. In Sweden, known for its generous parental leave policy, mothers get 16 months.

Shiu Ka-chun, Hong Kong’s legislator for the social work sector, says fathers want to do more at home but employers prevent them doing so.

“Fathers want to take care of their newborns too, but our society strips them of the opportunity to do so, which leaves the mothers feeling neglected and alone,” he says.

More should also be done to encourage the birth rate, Mak adds. He suggests following in the footsteps of Singapore by introducing subsidies for families with newborns.

Most importantly, Mak says society should be more aware of postnatal depression and steer greater medical resources into improving detection.

“Don’t only pay attention to the baby – also help the parents,” he says. “Ask them if they need help with anything.”