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Meghan Markle's revelation that she struggled with her mental health while pregnant may help to normalise perinatal depression for other women Image Credit: AP

There were many revealing allegations in Meghan and Harry, the Duke and Duchess of Sussex’s interview with Oprah Winfrey earlier this month.

But perhaps the bravest of all was Meghan’s admission of her mental health struggles during her pregnancy, and how unsupported she felt by the royal family.

Although Meghan did not specify whether she was formally diagnosed with clinical depression, her revelation that she “didn’t want to be alive any more”, at a time when she was pregnant and being hounded by the UK press, touched on a topic that still remains taboo and yet all too common. “In high-income countries, 7-20% of women experience depression during pregnancy,” says Dr Rebecca Steingiesser, Clinical Psychologist and Clinical Neuropsychologist at The LightHouse Arabia. “Women often feel like they are not responding to pregnancy as they feel they are ‘supposed to’ and feel ashamed of their depressive thoughts and experiences.”

While Meghan’s own situation was of course unique, by admitting so publically that she struggled emotionally while pregnant, she kick-started a conversation about perinatal mental health that may help to normalize the feelings of many others pregnant women across the world.

Likewise, Harry’s confession that he “had no idea what to do” when she confided her struggle to him encapsulates the feelings experienced by many family members of someone grappling with a mental health crisis.

But all spouses and family members of pregnant women should be aware of the possibility of perinatal mental health challenges (meaning both during and after pregnancy) and how best to support their loved one. This is what experts advise:

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Meghan is pregnant with the couple's second baby, which they revealed is a girl in the interview with Winfrey

Normalise the emotions

A sense of shame characterized the feelings of both Meghan and Harry. "I was really ashamed to say it at the time and ashamed to have to admit it to Harry, especially because I know how much loss he's suffered, but I knew if I didn't say it, that I would do it," Meghan told Winfrey.

Meanwhile, Harry said discussing mental health with his family "is just not a conversation that would be had."

Dr Steingiesser says that a sense of shame is very common in pregnant women who are feeling depressed - exacerbated by the idealistic image that society has of pregnancy as a sacred time of ‘glowing motherhood’. “These feelings of shame and disappointment get amplified when someone else points out mistakes or faults or suggests that they “should be lucky and happy” and that there is no reason for them to be feeling the way that they do,” says Dr Steingiesser.

Repressing or ignoring the situation - as the couple allege the rest of the royal family did - is not helpful in this scenario. “Ultimately, normalizing a new mother’s experience of mental health challenges should be the focus,” continues Dr Steingiesser. “It is imperative that mothers recognize how common and normal it is to experience feelings of sadness or worry and that this does not need to be something to be shameful of or a topic to avoid speaking about.”

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Meghan and Harry's candid interview with Oprah, in which she revealed her perinatal mental health struggles, has sent shock waves through the UK royal family

Don’t delay getting help

Not treating perinatal depression can have devastating consequences – not only for the woman, but the stress of anxiety of depression during pregnancy can have a very real impact on the growing baby too. “Strong, frequent and prolonged activation of the body’s stress response system without any kind of treatment or buffer to support it can have long-lasting negative side effects on the development of the baby as well as the pregnant woman,” says Tooba Sidiqui Clinical Psycologist, Medcare Camali Mental Health Clinic.

A new animal study in the US published in the journal Scientific Reports found that pregnancy stress can lead to inflammation in the fetal brain - the source for a child’s future anxiety and other psychological problems identified in previous research. “Women with perinatal depression may experience negative thoughts and suicidal ideations, which, in turn, interfere with self‐care, reaching out for support and the motivation to bond with the infant,” adds Sidiqui. “Common negative consequences for mothers experiencing depression include decreased support from the family unit and social support network, decreased ability to take care of oneself, poor nutrition and weight gain, substance use, relationship difficulties with partner and impaired interaction with the infant.”

The sort of suicidal ideation that Meghan described can also be a very real threat, says Dr Steingiesser. “Women with untreated perinatal depression are at higher risk of harming themselves, attempting or succeeding in ending their lives and may also be more likely to attempt to harm their baby.” The key is to get help as soon as possible: “As with any mental health disorder, the sooner the issues are addressed, the more promising the prognosis and the easier it is to manage these symptoms in the longer term.”

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Meghan said that although the couple may have appeared normal and happy in public appearances, the reality was very different

Validate their feelings

Meghan told Winfrey that her requests to the palace for mental health support were rebuffed, despite her reaching out to family members and even the HR department, "begging for help, saying very specifically, 'I'm concerned for my mental welfare.'"

But minimizing a woman’s feelings will only make things worse, says Sidiqui. “Mental illness can make many people feel very isolated. Tell them they’re not alone. Be there for them, even if you don’t have a similar personal experience. Telling someone that they’re important to you, that you need them in their life, and that they matter can be very comforting. Acknowledging how hard depression and its symptoms can be will help them feel ‘seen’. It’s a good reminder that you’re listening, you see them, and you’re here to help them cope.”

Meghan Markle’s reported experience of not receiving support whilst facing an increased amount of stress during pregnancy is not uncommon, says Dr Steingiesser. “She reported feeling alone and judged, with these being commonly reported concerns from mothers. As we know and can be particularly harmful to both the child and the mother’s physical and mental health. It is important to understand and respond to distress during this time and seek help as early on as possible.”

Without any formal screening process in the UAE to identify perinatal depression, it’s important for partners to check in with their loved ones regularly, so that any potential problems get addressed quickly. Encouraging your loved one to connect with others in the same boat can also be helpful. The Lighthouse Arabia offers two, free community support groups run by Dr Rebecca Steingiesser that are dedicated to these issues: “Motherhood in the early years” and “Postnatal mental health”, which run monthly and aim to provide women with a safe, secure and non-judgmental space to share their experiences and receive support from other mothers’ who are experiencing similar challenges.

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Now that the couple has moved to the US, Meghan says she feels a lot happier and more free

Help them get support – but help yourself too

If your wife, friend or family member says they are struggling with their mental health, be ready to support them and to suggest places where they can get professional support.

Meghan said Harry "cradled" her when she told him. Then, at a public event they attended together soon after, Meghan said the couple were photographed holding hands so tightly you could "see the whites of our knuckles."

"We're smiling and doing our jobs, but we're both just trying to hold on," she said in the interview.

Sticking by the side of someone experiencing serious depression is very important, says Dr Steingiesser. “Loved ones play a significant role in helping a woman overcome perinatal depression. One of the most common experiences in perinatal depression is an overwhelming sense of loneliness and significant others can certainly help alleviate those feelings, by simply being present, providing emotional support and assisting in any way possible. This means ensuring the mother is able to have alone time - time to sleep, bathe in peace and have time to engage in any self-care practices necessary to help her feel settled and balanced.”

Sidqui adds: “If you think that the mother may have depression or anxiety, talk to a health care professional right away. Getting treatment early is important for her health and the baby’s health. And lastly, when you bring home a baby, you also bring home a mum.”

It is completely normal to feel helpless and unsure as to how to support mothers during this time, says Dr Steingiesser. “Loved ones can also encourage women to seek help to address their mood and emotional difficulties. It is also particularly important for loved ones to be aware of their own feelings. Perinatal depression can lead to depressive feelings in the partner of the mother. Partners need to also be aware of and take care of their own mental health in order to support the mother in her journey.”

How to react if your pregnant loved one asks for help
Tooba Sidiqui, Clinical Psycologist at Medcare Camali Mental Health Clinic, shares her advice…

Asking what you can do can really help them through their day. Maybe they’re not eating well, and you can pick up dinner. Maybe they need a morning call or text to ensure they get to work on time. Sometimes you just need to listen. Helping doesn’t have to be a huge, drastic effort. It can be as simple as picking up a phone, sharing a meal, or driving them to an appointment.

Don't accuse, threaten, blame, or make light of what your friend or loved one is feeling. Don’t tell them to “Just think happy thoughts. I don’t understand what you have to be so sad about. You’re being thankless. You just need to snap out of this. So many childless people out there are worse off than you.”

Don’t take responsibility for what they’re feeling or blame yourself for causing it in any way. If your friend has not yet seen a doctor, encourage them to seek help and reassure them that there is nothing wrong with asking for assistance. If your friend is already seeing a doctor, offer to help with picking up medications and being on time for appointments.