"People often hear about postpartum blues when having a baby, but the emotional well-being of adoptive parents once the child is placed in the home is not really talked about," said Karen J. Foli, an assistant professor of nursing and an adoptive mother. "In this study, the majority of the adoptive parents who self-reported having experienced depression after the child was placed in their home often described unmet or unrealistic expectations of him or herself, the child, family and friends, or society.

"For example, some parents shared that they did not anticipate that bonding with their child would be a struggle or that family members or friends would not offer the same support that birthparents enjoy."

The signs and symptoms of depression include depressed mood, decreased interest or pleasure in activities, significant weight changes, difficulty sleeping or excessive sleeping, feeling agitated, fatigue, excessive guilt and shame, and indecisiveness.

"Postadoption depression not only affects the parents, but it also has an influence on the well-being of the child," she said.

Foli, who is co-author of the book "The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption," interviewed 21 adoptive parents about their adoption and depression experiences, as well as 11 adoption experts and professionals. The adopted children's range of age at placement was newborn to 12 years, and when the study was conducted the children's ages ranged from 12 months to 24 years. Foli's findings are published in this month's Western Journal of Nursing Research.

"Many adoptive parents spend their time during the adoption process demonstrating they are not only going to be fit parents, but super parents, and then they struggle with trying to be the world's best parent when the child is placed in the home," Foli said. "Adoptive parents also may experience feelings about their legitimacy as a parent, or even surprise if they don't readily bond with the infant or child."

Other factors that contribute to postadoption depression may include the expectations surrounding the child's attachment to the parent, a lack of peers, the lack of boundaries with birthparents in open adoptive agreements, and society's attitude toward adoptive families as a whole. Adoptive parents also are tired by the time the child comes into the home, Foli said. They have endured a rigorous adoption process and much of their lives have been out of their control.

"Obtaining that next form or checking that next box while waiting for the child can shift the focus away from parenting and emphasize the process of adoption," Foli said.

It's estimated there are 2 million adoptive parents in the United States. Adoptions can take place through public agencies, international organizations, private organizations, kinship agreements or tribal adoptions.

"Even though adoption continues to grow in the United States and become more mainstream, there is conventional wisdom that implies adoption was 'Plan B' for the parents," Foli said. "New adoptive parents often realize they weren't as prepared as they thought they were and the child's needs may overwhelm them. Some family members may not be receptive to news about an adoption or they may even treat the adopted children differently. Some parents in the study reported that acquaintances or strangers felt entitled to ask probing questions about the adoption, such as, 'How much did the child cost?'"

The adoption professionals who participated in the study said parents were often reluctant to admit their struggles out of fear and shame. Parents also echoed feelings of extreme guilt and confusion over how they were struggling, particularly after their intense longing and eagerness to bring a child home.

"We need to empower parents to share their feelings with adoption-smart professionals, online or face-to-face support groups, trusted significant others, and friends," Foli said. "Parents should realize they are not being disloyal to their children or families to feel the way they do. Health-care providers, especially nurses, can be instrumental in detecting issues related to depression or the mental well-being of the parents. Being more open about such concerns can lead to a healthier, happier family. By helping themselves, they are helping their children."

This research was in association with a book project supported by Rodale Press.

Note: If no author is given, the source is cited instead.

• Children's Health
• Mental Health Research
• Pregnancy and Childbirth

• Child Psychology
• Child Development
• Psychiatry

• Postpartum depression
• Baby colic
• Maternal bond
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• Toddler
• Stillbirth