Eight years ago, I found myself struggling with a darkness that made me feel I had lost my way and couldn't bond with the baby girl I had desperately wanted to adopt. Unsure of where to go for help, I searched online for anything I could find on adoption and depression. Two articles helped me realize I wasn't going crazy-indeed, I felt empowered.
The first was by June Bond, who described the depression that some adoptive parents experience (see http://bit.ly/izNf0). The second was by Harriet McCarthy, an adoptive mother who surveyed adoptive parents online and found that a majority had experienced depression (see http://bit.ly/kjWRQ).
I soon began interviewing fellow adoptive parents who had experienced depression. I also spent many hours with adoption professionals and scholars, including Cheryl Beck, DNSc, CNM, FAAN, an expert on postpartum depression (see "Postpartum Depression: It Isn't Just the Blues," May 2006). The two-year process resulted in The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption, a book I coauthored with my husband, John Thompson, MD, a board-certified psychiatrist. Our qualitative work shows parallels between postpartum and post adoption "blues" and depression-but there are also important differences.
Adoptive parents, both moms and dads, may struggle with the stress, fatigue, and uncertainty of the adoption process; unresolved grief related to infertility; unrealistic expectations about parenting; and a lack of support from family and friends. Adopted children may have experienced trauma and abandonment that can interfere with attachment and bonding.
Many adoption agencies, Web sites, and online parent support groups now provide information on postadoption depression. The Child Welfare Information Gateway has information on postadoption services that might help struggling parents (see http://bit.ly/17iSqM).
Awareness is growing, but formal studies remain scarce. Opinion is trending toward acceptance: yes, postadoption depression exists, and yes, preva lence rates are similar to-perhaps higher than-the 10% to 15% rate for postpartum depression. However, most empirical studies use postpartum screening scales that have no proven reliability or validity in measuring postadoption depression, or they rely on general depression scales that may lack specificity in adoptive parents.
Adoption professionals say clients report feeling vulnerable about admitting they're depressed. I think their vulnerability is based on guilt, shame, and fear-of being seen as less than perfect and even of losing the child. It's important to appreciate that adoptive parents have, in effect, reached into the global community to have a child; they've applied for a license to parent and have had to convince others that they're not merely worthy, but are the best parents for a particular child. They've been at the mercy of legal systems and institutional bureaucracies. Adoptive parents may fear that what was given can be taken away, especially if they fail to fulfill their own expectations of being "superparents."
When assessing or treating parents who may be depressed, ask gentle, open-ended questions that signal your willingness to listen in a nonjudgmental way: "With birth moms, bonding can take time. I understand it can take time with adoptive parents, too." "Sometimes, parents can feel overwhelmed. How are you doing?" "How would you describe the support you've received since your child came home?"
Raising awareness about parental postadoption depression ultimately strengthens families and allows healing to occur. Nurses, as in so many contexts, have opportunities to influence outcomes and mitigate our clients' pain.