Markle’s story gave viewers a glimpse into the lack of support she says she received from the system meant to be providing a safety net. She says she reached out to both the Firm and the H.R. department within the monarchy and to specific family members for help but did not ultimately receive it. She (sort of) joked about not being able to Uber to the hospital from the palace. But that lack of validation she experienced can be disastrous for people struggling with suicide who finally decide to reach out; as Markle pointed out during the interview, it takes an incredible amount of courage to ask for help—to then be told no is devastating.
Vissing says it’s important for others to understand the struggle in the pregnant person’s mind. “It sounds a bit extreme but the logic of it is when you feel so bad about yourself, you feel you are the worst possible person, the worst possible parent,” she says. “It’s intense shame.”
You don’t have to have a history of depression to experience these thoughts
In a 2019 study published in the Journal of Affective Disorders, researchers found that women with depression were 13 times more likely to report suicidal ideations. However, you don’t have to have preexisting depression or anxiety to have suicidal thoughts, Vissing says—a third of the women with suicidal thoughts during pregnancy in the 2019 study did not report clinically significant depressive symptoms.
Depression during pregnancy can take wildly different forms for each individual. The core element, Vissing says, is a “deep sense of hopelessness.” For some, it manifests as “intense anger, irritability, and rage.” Trauma can make matters worse, whether from intimate partner abuse, childhood events, medical abuse, or sexual abuse.
Pregnant people can also experience “intrusive thoughts,” meaning passing thoughts such as “What would happen if I killed myself?” that don’t necessarily signify intent or major mental health disorders. “Intrusive thoughts are very common in pregnancy. It can be very scary and uncomfortable,” Vissing says, encouraging those with potential mental health disorders and those with fleeting intrusive thoughts alike to pursue help. “There’s no reason not to—there’s no issue too small.” Therapists can help with strategies and education surrounding intrusive thoughts to train people to recognize them and address them quickly.
A broken system for women of color struggling with mental health in pregnancy
Mental health conditions are one of the leading causes of maternal death during the postpartum period. Pregnant non-Hispanic Black women are more than three times more likely to die due to pregnancy complications than white or Hispanic women, the CDC reports, disparities that Vissing calls “staggering and deeply concerning.”
“It’s easy for me to say, ‘Reach out to your provider,’ but they know the system is not supporting them,” Vissing says. “We can’t put it all on the individual and see it as an individual’s responsibility. Pregnant moms are really angry and frustrated and have good reasons to be.”
The solution starts with better support for pregnant people. Vissing challenges pregnant people’s friends, family, and neighbors to go there when it comes to asking the tough questions about mental health during pregnancy. It could be a lifesaving conversation at a time when everyone else, including ob-gyns, may be focusing more on the baby’s health and development, she explains. Don’t be afraid that you could “plant the idea” or make it worse, a serious barrier to these conversations, she says. “We need to get over that. The opposite is true.” If you’re not sure how to broach the topic, Vissing suggests saying something like: “I know this is heavy stuff, but it’s important and I really care.”
Medication like antidepressants and talk therapy can be powerful long-term tools for pregnant people who are struggling. But if you are having suicidal thoughts, call the national suicide hotline or tell a health care provider to get immediate help. If you aren’t comfortable with your provider or need help finding a new one, Motherfigure offers a database of providers that specialize in maternal mental health among other resources for pregnant people.
“The good news is this is treatable and preventable,” Vissing says. “We can reach those people and give them hope and connect with them—it is through the connections with others that they will come out of that state.”