The trouble with boys part 1: the story of two results

Postnatal depression is all too common – the standard figure quoted is that it occurs after about 10% of births, but this was recently found to quite dramatically underestimate rates of the condition worldwide. Postnatal depression is associated with a range of detrimental outcomes for both mothers and their children, and the costs of treating are perinatal mental illnesses are immense – for instance, it was recently estimated to cost the UK’s National Health Service £1.2 billion per year.

It is perhaps not surprising then, that when our new study identifying an easily observable (yet previously largely unrecognised) factor increasing the likelihood of postnatal depression by 174% came out, it received some press attention. I say ‘some’ press attention, in fact it was really rather a lot – the study was featured in at least 131 stories in print media, 7 radio broadcasts, and 3 TV news reports within a few days of publication (we even made People Magazine!).

However, the focus of these reports was not the finding that something health professionals don’t currently consider to be a major risk factor for postnatal depression, and yet document as a matter of course, increases the risk of the condition by 174%. Instead, they all focussed on the finding that something else, granted as easily discernible, increased the likelihood of postnatal depression by 73% – why?

Was this seeming discrepancy due to deliberate spin placed on the findings, either by the University or us the researchers, to grab attention? I’d like to think not – both factors are in the title of the paper and the first lines of the press release…

Instead, I think the reason will become more clear when I disclose that the factor we found to  increase the likelihood of postnatal depression by 174% is the experience of complications during childbirth, whereas the factor increasing the likelihood by a relatively meagre 73% is the giving birth to a son.

The tabloids loved it! The tone of much of the reporting is neatly summed up in the headline ‘Mothers of male infants, take note!’ – as if by dramatically warning mothers, they’ll magically be able to prevent themselves becoming depressed, and thereby avoid the danger of damaging society’s precious male heirs. (And yes, I am aware its statements like that which cause the comments fields on such news reports to fill with accusations that I’ve been “blaming men since birth”!)

Instead of being helpful to new or expectant mothers, it is arguably very harmful to engender fear over something they cannot control – the mechanism underlying both these findings is thought to be an inflammatory immune response, triggered in response to gestating a male foetus or injury during labour. The paper was firmly aimed at health professionals, with a view to increasing their knowledge of the factors which may leave a woman at elevated risk of becoming depressed, so that the limited resources which accompany mental health provision can be more efficiently targeted. Rather than articulating this, much of the media reporting simply fed into a wider, highly problematic narrative surrounding motherhood which emphasises the risks of maternal behaviour towards infants.

How as researchers do we prevent our findings causing unintended harm? We could have not put out a press release, and left academics to find our results for themselves. But this radically reduces the chances of their being noticed by the wider public health community – as it is, our paper came to the notice of the Royal College of Midwives (so mission accomplished!).

A more productive solution seems to be to actively engage with the media, wherever possible, and otherwise to convey the purpose and nuance of research findings to a popular audience ourselves, wresting control of the message of our work. Hence this blog…

Myers, S. and Johns, S.E. (2019). Male infants and birth complications are associated with increased incidence of postnatal depression. Social Science and Medicine 220: 56-64