For those suffering from perinatal depression or anxiety, the details of the tragic case of a mother charged with murdering her three children have been particularly affecting. Kristina Grace reflects on the issues the trial has raised.

Content warning: mentions of suicide, self-harm, infanticide and murder, but no graphic detail is given in this story.

NB: Perinatal refers to the pregnancy stage and first year postpartum but depression/anxiety can last much longer than one year following its onset at pregnancy/childbirth.

The trial of Lauren Dickason, who was found guilty of murdering her three children, has been front-page news for the last four weeks in New Zealand, and has brought the topic of postnatal depression into the spotlight. The jury had to decide whether Dickason had unresolved postnatal depression that led to psychosis, or whether in fact her depression had been resolved when she came off her medication a month before her children were killed. 

Many of our mothers seeking help for perinatal depression/anxiety have been greatly affected by the story, by the charges against Lauren Dickason, by the prosecutor’s accusations, by the media coverage, and by public response both on social media and in the circles around them.

Many of our mothers have also been affected by the graphic descriptions of how the children died and the way it’s been reported. Therefore, we felt it was important to address the many issues this trial has raised, to voice the fears and concerns some of our mothers with perinatal depression/anxiety have expressed, and to clear up any misunderstandings.

The concerns and fears of mothers with perinatal depression/anxiety (PNDA)

Many of our mothers have been triggered by what they describe as “insensitive and judgmental comments” on social media towards Lauren Dickason. Some even feel the attitudes they’re reading about take New Zealand backwards in terms of reducing stigma around mental health and particularly maternal mental health. They feel like there is a general lack of understanding of what perinatal depression/anxiety really looks like and an expectation that they should be “coping” and “enjoying” motherhood rather than appreciating how difficult the reality can be. There has also been a worry/fear that if they express distress, people will automatically think they will hurt their baby. One mother said she’s even afraid to talk to her husband in case he thinks that she’s at risk of hurting their children.

The facts about infanticide

The terms “infanticide” and “insanity” that we’ve heard being used as we have followed this case over the last four weeks have legal definitions that were helpfully explained in this article. Child abuse is high in New Zealand (150,000 cases are reported every year to Oranga Tamariki), and a child is killed every five weeks – 27% of those are by their mothers (approximately four to five children per year are killed by their mothers). The majority of those who are killed by their mother is as a result of infanticide relating to mental illness rather than as a result of abuse. Most mothers in these cases want to die but have the delusion that it would be better for their children to die also and see it as a mercy, which is part of the psychosis.

While infanticide is rare, what is common is a mother’s thought of harming herself or her child alongside perinatal depression/anxiety. The vast majority won’t act on it. It’s really important that mothers know how common those thoughts and feelings are and that if they are honest about it, they will get help rather than fearing that their children will be taken away from them (which is often why they keep their silence). I want to reassure families reading this that in my 13 years of working in this field, it is extremely rare that Oranga Tamariki gets involved with our clients – maybe a handful out of hundreds that come to us every year. It’s so important that mothers feel that it’s safe to reach out for help.

While many mothers experience these intrusive thoughts, just as many mothers don’t – and their perinatal depression/anxiety is no less valid. 

Signs of perinatal depression/anxiety

Some of the common symptoms of PNDA are tearfulness, low mood, irritability/anger, not enjoying things that used to be enjoyed, difficulty concentrating, difficulty with sleep (sleeping too much or trouble getting to sleep/staying asleep even when baby is sleeping), poor appetite or overeating, low energy, low motivation, thoughts of self-harm or suicide.

A mother can see whether she might have depression/anxiety by checking her Edinburgh score and following the advice given with the results.

Risk factors for perinatal depression/anxiety

Lauren Dickason had a lot of risk factors. She had a previous history of depression, she had difficulty conceiving and then IVF treatment, she had a miscarriage, she had multiples (twins), she had babies during the Covid pandemic and she was a new migrant. New migrants have a high rate of PNDA – up to 30% of new migrant mothers experience it. Apart from the stress of moving to a new country and new community, they are usually leaving behind their support network and extended family while also adjusting to significant change in an unfamiliar place. In the case of the Dickason family, they were also fleeing traumatic scenes and violence with the recent riots in South Africa.

Previous depression is the strongest risk factor for PNDA. We are seeing a lot of mothers who have longed for a baby and had trouble conceiving receiving help from IVF only to find motherhood to be extremely stressful, and then experiencing guilt that they’re not enjoying it. We had a huge increase in birth trauma and depression/anxiety among mothers during the worst of the Covid pandemic. This is because mothers were often separated (or experienced reduced support) from their partner and families as well as reduced in-person support from midwives and other maternity clinicians. Due to staff shortages in maternal health and ongoing incidences of Covid, these effects are still being felt.

Other risk factors include intimate partner/family violence, poor family support, breastfeeding issues and prolonged sleep deprivation (less than five hours unbroken sleep). As you can see, most mothers will have some of these risk factors. The perinatal stage is a time where a woman or birthing person will be most vulnerable to developing depression/anxiety.

Accusations from the prosecutor

I think some of the comments from the prosecutor in this case have been both misleading and unhelpful. He suggested that two years post-birth can no longer be considered perinatal depression/anxiety, but that’s not how PNDA works. Mothers who have had depression/anxiety in response to difficulty conceiving, miscarriage, IVF treatment, birth of multiples (or birth in general) can develop a chronic condition as a result of perinatal depression/anxiety if not adequately treated. And severe untreated depression can lead to psychosis. Since she stopped taking her medication one month before killing the children, it is very possible that she developed psychosis, and this was the opinion of the psychiatrist for the defence.

Where to get help

Mothers Helpers specialises in maternal mental health and while we do not have any government contracts in place, we have worked hard to find other funding and can provide free clinical assessments, free group therapy, free birth trauma counselling, and psycho-educational antenatal classes. You can refer yourself or someone else to Mothers Helpers here.

Need to talk? Free call or text 1737 any time for support from a trained counsellor

If you’re worried about safety

If there is an immediate risk you should call 111. If the risk is there but not immediate, you should contact your local crisis team – numbers are found here.