Before being diagnosed with postpartum depression, Nicole Gamble often felt isolated even though many of her loved ones lived nearby.
That's why the Winnipeg maternity nurse -- and mother to Oliver, 16 months -- wasn't shocked when she heard about a headline-making study released last week.
The findings, published in the Canadian Medical Association Journal, suggest new mothers living in rural areas are less likely to experience postpartum depression than those living in big cities.
"I had a lot of family around me -- I still have a lot of family around me -- that live in close proximity to me," says Gamble, who has a theory about the surprising phenomenon cited in the study.
"In rural areas. I think there's just more of a sense of community. It's just more tight-knit. There's almost that village mentality," she says.
Gamble, who founded a free postpartum depression support group five months ago, hypothesizes that friends, family and neighbours in rural areas likely help with daily chores and offer more social support to new moms than in the city "so that the mother can focus on her recovery."
The CMAJ study is based on a 2006 survey of nearly 6,500 new mothers across the country. It found almost 10 per cent of women living in cities with a population of at least 500,000 reported experiencing postpartum depression. That compares with six per cent of new moms in rural areas, almost seven per cent in semi-rural, or small-town areas, and about five per cent in semi-urban areas, the latter defined as having a population of 50,000 to 500,000.
Lead author Dr. Simone Vigod, a psychiatrist who specializes in maternal mental health at Women's College Hospital in Toronto, says she decided to do the study to better understand postpartum depression risk factors "so we can prevent it or treat it in its early stages."
The study is especially meaningful just a few weeks after the death of Lisa Gibson, a Winnipeg mother who committed suicide after apparently drowning her two children in a bathtub.
Many speculate Gibson suffered from an extreme form of postpartum depression, perhaps psychosis. Those who knew her say they were shocked to learn of recent events and considered her a kind woman and good mother who was highly intelligent.
Vigod admits she was surprised by her study, too. Like others, she assumed women living in big cities would report less postpartum depression considering they have access to a whole city's worth of medical professionals and other resources.
"Is it possible that women living in smaller areas have more access to family support? Do they have more access to other women in the neighbourhood?" asks the psychiatrist.
Vigod says she wants to help women understand postpartum depression is nothing to be ashamed of.
"This is a treatable illness and women have a right to be treated."
But how do you know if you have it?
She says 50 to 80 per cent of women might experience the so-called "baby blues." This harmless condition is not postpartum depression and is characterized by emotional changes such as "crying at a drop of a hat," often out of fear something bad could happen to your baby.
"If you burst into tears but then five minutes later you feel OK? Then that's probably baby blues."
"But it's when you feel persistently bad, persistently anxious, not being able to sleep when the baby sleeps, not feeling attached to your baby at any point during the day -- these are real signals that something could be wrong," says Vigod, noting postpartum depression can be mild, moderate or severe.
Even in mild cases, mothers can have visions of harming their children.
Treatment for postpartum depression includes talk therapy, medication and social support groups.
Triggers include major life stressors before, during or after pregnancy, a feeling of isolation and fluctuating hormones, often combined with other biochemical factors.
The most severe postpartum difficulties come with psychosis, and Vigod says between one and 1,000 women develop this. "Essentially the woman loses touch with reality. That can happen abruptly with a lot of confusion, hearing voices," she says.
Vigod says her study -- and the Gibson case -- should be a wake-up call to mothers, their families and medical professionals to be on the lookout for postpartum depression and to have "pathways of care" in place for such patients.
Gamble says when she first sensed something was off, she was afraid to come forward to a health professional out of fear authorities would take her child away.
"Intrusive thoughts are what led me to seek treatment," says Gamble. "(They were) quite scary, quite terrifying.
"Some of them are very personal and I don't want people to think I am a monster," says Gamble, who has made it her mission to share her story with the public.
"Even though I would never do anything like that and the thought sickened me, the thoughts made me feel like a monster," says Gamble, noting none of her physicians screened her for postpartum depression.
Gamble says after finally seeking help from mental-health professionals and being told she did not qualify for their services -- or that there was a two-year waiting list -- she eventually found the help she needed.
She also founded what she says is the only postpartum depression support group in Winnipeg.
"I felt I needed that peer support with other moms going though it at the same time. To have a story of hope out there from a mom saying, 'I've recovered. It can happen for you, too.' I just needed that light at the end of the tunnel," says Gamble.
Lori Orchard, a mother-of-two who has lived in Oakbank -- population 300 -- for 25 years, has another theory about why postpartum depression may occur less in rural areas: More awareness of services, even if few.
"We have a number of children and baby groups in our area. It's through the school. It's through the public nurse," says Orchard, a fitness instructor who runs the gym at Concordia Hospital where Gibson once worked.
"She was very sweet. Just a nice person. So it's very tragic."
-- With files from The Canadian Press
Have an interesting story you'd like Shamona to write about? Contact her at Shamona.email@example.com.