A mother and her four children were found hanging from a clothes rod Tuesday morning, in what marks Texas' fifth murder of children by their mother over the last six years.
As officials further investigate the tragedy, experts are calling attention to the possibility that this was a result of postpartum depression and the importance of screening for the disorder.
The Houston woman, identified as Gilberta Estrada, was found dead alongside her daughters, the youngest of whom, an 8-month-old baby girl, was alive but in critical condition.
Parker County Sheriff Larry Fowler indicated that reports from her family said that Estrada was suffering from depression, possibly a result of a recent separation from her husband.
These factors could contribute to postpartum depression, according to Dr. Lauren Streicher, a clinical instructor in obstetrics and gynecology at Northwestern Medical School.
"Postpartum depression has gone unrecognized in the past," Streicher said. "People really need to identify what it is and what it isn't. … The potential is grave for someone who goes untreated."
Postpartum depression is an illness that has plagued mothers since as early as ancient Greek times.
But only since the 2001 case of Andrea Yates, who drowned her five children in the family's bathtub, has a spotlight been thrown on the disorder.
In fact, postpartum depression affects 10 percent of mothers, according to Streicher.
What triggers this depression remains unknown, but many believe fluctuating hormones before, during and after pregnancy play a part.
During pregnancy, the levels of female hormones estrogen and progesterone boost dramatically, according to the U.S. Department of Health and Human Services.
After childbirth, these hormones rapidly decrease to their normal pre-pregnancy levels. Because just a small change in hormone levels is known to affect a woman's mood, a number of researchers suspect this phenomenon contributes to depression.
However, the role of hormonal changes as a causative factor remains unclear. "There are other, very specific risk factors for postpartum depression," Streicher said.
If a woman has a personal or family history of depressive disorder, is involved in marital problems or has an unplanned pregnancy, she may be at higher risk for developing more severe depression.
"Postpartum depression is not always obvious," said Dr. Shari Lusskin, director of reproductive psychiatry at the New York University School of Medicine. "Most women suffer in silence. By the time they complain, it has gotten much worse."
Recognize the Symptoms
Knowing what to look for and how to react could be keys to preventing tragedy.
"The earlier you can identify and treat depression, the better the outcome for mom, baby and family," Lusskin said.
However, if you want to recognize the signs of postpartum depression, it is important to differentiate it from the normal baby blues.
"Mood swings, insomnia, crying are normal and not dangerous," Streicher said. Nearly every new mother experiences these symptoms.
But if a woman's feelings of depression build, and she begins expressing agitation, extreme fatigue and a lack of motivation, it may be a more serious problem.
"This goes way beyond feelings of anxiety or depression," Streicher said. The woman is "not herself and doesn't bond with her baby."
Often women feel guilt and fear over their symptoms. They don't want to admit they lack the natural feelings of love toward their child, and are afraid of drastic action, like hospitalization.
"Women remain afraid to admit they're feeling depressed," Lusskin said. "The family has to act as an advocate."
Streicher agreed. "Be aware of someone who's more than just a little weepy," she said. "If you see someone who's having issues with depression, let them know there's help out there."