Postnatal depression in Singapore: signs, screening and where to get help

Postnatal depression in Singapore affects about 10 to 15% of women after childbirth, SingHealth says, and about 3 to 5% have depression moderate or severe enough to need medical care. It's different from the baby blues, which hit up to two-thirds of new mums in the first week and fade within days to a couple of weeks. If low mood, anxiety or hopelessness lasts longer than two weeks, see a doctor. You can start with the free 10-question EPDS self-check on HealthHub, then see a GP, polyclinic doctor or your obstetrician. A polyclinic or CHAS GP referral gets you subsidised rates at KKH, where a specialist visit costs S$37.20 to S$101.49 for Singapore Citizens. If you're having thoughts of harming yourself or your baby, go to the nearest A&E now or call SOS on 1767.

Baby blues, postnatal depression or postpartum psychosis: side by side

These three get mixed up, and the difference decides what you do next. If you think it could be psychosis, our postpartum psychosis signs checklist tells family what to do. The table puts SingHealth's and NUH's descriptions next to each other.

SingHealth says some mums with postnatal depression also get obsessional symptoms: unwanted thoughts about harm coming to the baby, or fears of dirt and germs that drive repeated washing. These thoughts are a symptom, and a doctor will not take them to mean you want to hurt your baby. If anger is the feeling that won't go away, our guide to postpartum rage explains when it points to something more.

Signs of postnatal depression to watch for

You don't need every sign to deserve help. If several of these have lasted more than two weeks, or any feel severe, talk to a doctor. The list combines what NUH and SGH tell mums to look out for:

• Low mood, sadness or feeling empty, or irritability and anger at yourself or people around you
• Losing interest in things you used to enjoy
• Sleeping badly even when the baby sleeps, or sleeping far more than usual (our guide to new parent sleep deprivation covers ordinary exhaustion and how to share nights)
• Eating much more or much less than usual
• Feeling guilty, worthless or like you're failing as a mother
• Trouble concentrating or remembering things
• Worrying constantly about the baby, or panic attacks; our guide to postpartum anxiety covers anxiety and intrusive thoughts
• Pulling away from your partner, family or friends
• Thoughts of harming yourself or your baby

SingHealth notes the signs often go unnoticed until two to three months after the birth, because tiredness and poor sleep look like ordinary newborn life. KKH's specialists add that some mothers get unwell after the first month, once a confinement nanny has left, so keep an eye on your mood through the whole first year.

It is common, and it is not your fault

KKH's Psychological Medicine department cites studies suggesting up to 20% of women have mood or anxiety disorders during pregnancy and after delivery. KKH also found that only one in six pregnant women and new mums in its survey would seek professional help for symptoms of depression, so many mums carry this alone.

Nothing you did caused this, and SingHealth lists the usual contributors: hormonal and physical changes, broken sleep from night feeds, distress about weight and body shape, lack of support, money or family problems, and a hard confinement month. None of that is about loving your baby less.

Fathers and partners can get depressed after a baby arrives too. In dads it often looks like irritability, withdrawing into work or drinking more, rather than obvious sadness. HealthHub points fathers to the Centre for Fathering, and the same doctors and helplines below are open to them.

Most mums recover once they're treated: KKH reviewed 118 women treated for depression in pregnancy and found eight in 10 were discharged well and stable after a few months.

Why mums keep it quiet, and how to ask for help

Most mums with postnatal depression don't tell anyone at first. In a KKH survey of about 600 pregnant women and new mothers, only one in six said they would seek professional help for symptoms of depression. A second KKH survey found that more than 90% of patients rarely raised mental health with their O&G, and more than half of the O&Gs said they seldom started the conversation themselves. So if nobody has asked you, that's normal here, and it's still worth saying something first.

SingHealth says pregnant and new mothers often hold back because of fear of what others might think and worry about medicine. The fears are real, and so are the answers to them:

If the words won't come in the consultation room, read one of these out, or show it on your phone:

• "I had my baby eight weeks ago. For the past three weeks I've felt low or anxious most days, and it isn't lifting."
• "I'm not sleeping even when the baby sleeps, and I've stopped enjoying anything."
• "I scored 14 on the EPDS self-check on HealthHub, and I'd like to be assessed."
• "I've had thoughts that frighten me, and I need to tell someone."
• "Can you refer me to KKH's Women's Mental Wellness Service or a psychiatrist at subsidised rates?"

For a partner or parent, keep it short and specific: "I'm not okay, and I want to see a doctor this week. Can you mind the baby on Tuesday morning so I can go?" If your family brushes it off, NUH's Dr Cornelia Chee says the family should step in when a mum is struggling, and that doctors, your O&G or even your baby's paediatrician can ask about your mental health. Bring someone to the appointment and let the doctor explain it to them.

Who is more at risk

Anyone can develop postnatal depression, but SingHealth and KKH flag these as raising the odds:

• Depression or anxiety in the past, such as after a previous birth
• A difficult or assisted delivery, such as forceps, vacuum or caesarean, or other obstetric complications
• An unplanned or medically complicated pregnancy, or a pregnancy that followed infertility or a miscarriage
• Being under 21, or an older mother
• Little practical or emotional support at home, or marital problems
• Money worries or family problems

If any apply to you, mention it to your O&G early, ideally during pregnancy. SingHealth says a severe episode in one pregnancy can come back in the next in up to half of women, so early advice matters.

The EPDS: how screening works in Singapore

The Edinburgh Postnatal Depression Scale (EPDS) is the questionnaire Singapore hospitals use to screen for depression around pregnancy. You can take it at home or at a hospital check-up.

The EPDS is a screening tool. A high score is a reason to see a doctor, who makes the diagnosis after talking to you. If you'd like advice first, KKH's Women's Mental Wellness Service answers emails at pnd@kkh.com.sg within three to five working days.

Treatment: what actually helps

SingHealth says mild postnatal depression often improves with support and counselling from your family doctor, while moderate or severe depression needs a specialist. Most mums get a mix of:

• Talking therapy. SingHealth names cognitive behavioural therapy and interpersonal therapy as the approaches shown to help.
• Practical support at home so you can sleep and recover. It counts as part of treatment.
• Support groups, which SingHealth says many mums find useful for learning coping strategies from others.
• Medicine when depression is more severe. KKH and SingHealth both say there are antidepressants compatible with breastfeeding, and your doctor will choose with you; our guide to antidepressants in pregnancy explains the trade-offs. Don't start or stop medicine on your own.

Where to get help in Singapore, and what it costs

You don't need to wait until you feel desperate. Most mums start with the first or second option and get referred on.

KKH's fees are consultation charges only, and medicine and tests are billed separately. If you'd like a steadier base at home in the early weeks, practical help makes a real difference to mood. Our guide to hiring a confinement nanny in Singapore and our overview of the confinement period in Singapore go through the options, and the Fussy Mama Learn hub has more.

How partners and family can help

If someone you love has just had a baby and seems to be struggling, you don't need perfect words.

• Listen without judging or rushing to fix it, and let her say the frightening parts out loud too.
• Take on real work: feeds where you can, nappies, cooking, laundry, so she can rest.
• Protect her sleep. One unbroken stretch of a few hours can change how a day feels.
• Help her book a doctor's appointment, and offer to come along or mind the baby.
• Take any talk of self-harm seriously and get help the same day.
• Remind her often that this is an illness, and that she'll get better. If she says she feels nothing for the baby, our guide to not bonding with a newborn explains why and what helps.

If you're the partner and you feel low too, the same advice applies to you.

Looking after yourself while you recover

Recovery after birth is physical as well as emotional, and the two are linked. Rest, regular meals and a little time outdoors all help your mood. For hard moments, our guide to mindfulness for parents has breathing exercises that take two to five minutes. Having meals delivered lightens the week; our roundup of confinement food delivery in Singapore can help, and our guide to postnatal recovery after birth covers healing in the weeks after delivery.

If today feels heavy, take one small step: tell one person you trust how you really are, or book the doctor's appointment.

Frequently asked questions

How long do the baby blues last, and when does it become postnatal depression?

The baby blues start in the first week after birth and usually settle within a few days to about two weeks. SingHealth says that if symptoms last longer than two weeks, it's likely to be postnatal depression and you should see a doctor.

Can postnatal depression start months after the birth?

Yes. SingHealth says it usually develops within three to six months after delivery but can start any time in the first year. KKH's specialists have seen mums become unwell after the confinement month ends.

Can fathers and partners get postnatal depression?

Yes. In partners it often shows as irritability or withdrawal, or as working too much or drinking more, and it deserves the same help, and HealthHub lists the Centre for Fathering for dads.

Is it safe to take antidepressants while breastfeeding?

For many mums, yes. KKH and SingHealth both say there are antidepressants compatible with breastfeeding. Your doctor weighs the benefits and risks with you, and you shouldn't start or stop medicine on your own.

What is the EPDS, and is it a diagnosis?

It's a 10-question check of how you've felt over the past seven days, free on HealthHub and used by KKH at antenatal and postnatal check-ups. Because it only screens, a high score means you should see a doctor for a full assessment.

How much does it cost to see someone at KKH for postnatal depression?

KKH lists subsidised specialist visits at S$37.20 to S$101.49 for Singapore Citizens referred by a polyclinic, a public hospital A&E or a CHAS GP, and private first visits at S$170.48 to S$222.14, with medicine and tests billed on top.

Where can I get help in a crisis right now?

If you or your baby are in danger, go to the nearest A&E or call 995. To talk to someone any time, call SOS on 1767 or message SOS CareText on WhatsApp at 9151 1767. The national mindline is 1771, and SAMH's toll-free helpline is 1800-283-7019.

Will reaching out put my child at risk of being taken away?

This worry stops many mums from speaking up. Getting treatment is what doctors want for you and your baby, and early treatment is one of the best things you can do for your child.

Why do mums hide postnatal depression?

SingHealth says the usual reasons are fear of what others might think and worry about medicine. A KKH survey found only one in six pregnant women and new mums would seek professional help for symptoms of depression. Postnatal depression is a common medical condition, not a weakness.