When Motherhood Feels Harder Than You Expected: Understanding Perinatal Anxiety and Depression in Asian American Families

Written by Linda Clossey (LICSW), Asian Therapist in Massachusetts

Published August 2026

Many new parents expect exhaustion.

They expect interrupted sleep, feeding schedules, endless laundry, and the strange experience of realizing that someone else's needs now shape nearly every part of the day.

What can be harder to anticipate is the emotional experience.

The constant worry.
The guilt.
The feeling that everyone else seems to be managing better.
The thoughts that sound like:

"I should be grateful."
"Other people have it harder than I do."
"I wanted this baby. Why am I struggling so much?"
"I don't know why I can't relax."

For Asian American parents, the transition into parenthood can bring another layer of complexity. Family expectations, cultural values, immigration experiences, racism, changing relationships with parents, and beliefs about sacrifice and responsibility can all become more noticeable during pregnancy and after a child is born.

Sometimes the hardest part is not recognizing that something feels wrong. It is deciding that what you are experiencing is serious enough to deserve help.

At Elephant Room Counseling, we work with Asian and Asian American adults who are navigating anxiety, perfectionism, family expectations, relationship changes, identity shifts, and the emotional demands of becoming a parent.

Perinatal mental health concerns are common. They are also treatable.

And struggling does not mean you are failing at parenthood.

What Is Perinatal Mental Health?

The perinatal period generally refers to pregnancy through the first year after birth, although emotional and psychiatric symptoms can begin before pregnancy, emerge during pregnancy, or continue beyond the first postpartum year.

Perinatal mental health conditions include:

Depression
Anxiety
Panic attacks
Obsessive-compulsive symptoms
Trauma-related symptoms
Bipolar disorder
Postpartum psychosis
Significant emotional distress related to pregnancy, birth, or the transition to parenthood

The American College of Obstetricians and Gynecologists (ACOG) recommends that people receiving prenatal and postpartum care be screened for depression and anxiety¹ using validated tools (ACOG). Screening is recommended at the initial prenatal visit, later in pregnancy, and during postpartum care, with systems in place to ensure that a positive screen leads to appropriate assessment and treatment.

This is important because perinatal mental health concerns do not necessarily begin after a baby arrives.

In one frequently cited study², 27% of participants with postpartum depression reported that their depressive episode began before pregnancy, 33% during pregnancy, and 40% during the postpartum period. (Wisner et al., 2013)

In other words, waiting until after delivery to pay attention to mental health can mean missing an important window for support.

Perinatal Depression Is Common—But Statistics Don't Tell the Whole Story

You may have heard the statistic that postpartum depression affects approximately one in seven new mothers.

That estimate has been widely repeated, but it is based on older research and does not capture the complexity of how perinatal depression is identified today.

For example, in the same study² that I previously mentioned, it estimated a 21.9% period prevalence of depression during the first postpartum year among the population studied (Wisner et al., 2013).

More recent U.S. research also suggests that diagnosed postpartum depression has increased over time. A 2024 study examining more than 442,000 pregnancies found that postpartum depression prevalence increased from 9.4% in 2010 to 19.0% in 2021. The largest relative increase occurred among Asian and Pacific Islander participants³, although the authors appropriately noted that improvements in screening and diagnosis may account for part of the increase (Khadka et al., 2024).

These numbers are important, but they should not be interpreted as meaning that every Asian American parent has the same level of risk.

Asian Americans are an incredibly diverse population, and research findings differ by ethnicity, nativity, generation, healthcare system, and how mental health symptoms are measured.

The larger point is simpler:

Perinatal depression and anxiety are common enough that they deserve routine attention—not only when someone reaches a crisis point.

Perinatal Anxiety Can Look Very Different From Depression

When people imagine postpartum depression, they often picture someone who feels sad, withdrawn, or disconnected.

Perinatal anxiety can look different.

It may involve:

Constantly checking on the baby
Difficulty sleeping even when the baby is asleep
Racing thoughts
Fear that something terrible will happen
Excessive Googling or researching
Repeated reassurance seeking
Panic attacks
Feeling unable to trust someone else to care for the baby
Persistent physical tension
Irritability
Difficulty being present because your mind is always anticipating the next problem

A parent might say:

"I know logically that everything is okay, but I can't stop worrying."
"I can't turn my brain off."
"If I don't check one more time, something might happen."

For someone who already tends toward perfectionism or anxiety, parenthood can amplify those patterns.

Suddenly, there are hundreds of decisions to make every day.

What should the baby eat?
How much should they sleep?
Am I holding them enough?
Am I holding them too much?
Did I miss something?
Am I doing this right?

The pressure to get everything right can become exhausting.

When Anxiety Becomes Intrusive Thoughts

Perinatal OCD deserves particular attention because intrusive thoughts can be frightening and deeply misunderstood.

A new parent may experience unwanted thoughts or images about something terrible happening to their baby.

They might think:

"What if I accidentally hurt the baby?"
"What if I lose control?"
"What if something happens while I'm sleeping?"

The presence of an intrusive thought does not automatically mean that someone wants the thought to happen.

For some people, the distress comes precisely because the thought is so inconsistent with their values and sense of themselves.

They may respond by checking repeatedly, avoiding certain situations, researching symptoms, asking others for reassurance, or trying to suppress the thought.

This can create a cycle in which anxiety temporarily decreases after reassurance or checking, only to return again.

Perinatal OCD can be treated, and recognizing the difference between intrusive thoughts and intent is an important part of compassionate assessment.

Why Asian American Parents May Struggle in Silence

Culture does not cause depression or anxiety.

But culture can influence how people understand distress, how they talk about it, whether they seek help, and what kinds of support feel acceptable.

Some Asian American adults grow up with messages such as:

Work hard.
Don't complain.
Be grateful.
Take care of your family.
Don't burden other people.
Keep difficult things private.
Put the family's needs before your own.

These values can come from love, sacrifice, resilience, immigration experiences, and deeply held family traditions.

They can also make it difficult to recognize when someone needs support.

A parent may think:

"My parents immigrated here and sacrificed everything."
"They didn't have the option to complain."
"I have so much more than they had."
"I should be able to handle this."

The result can be guilt layered on top of anxiety or depression.

Instead of:

"I'm struggling and I need help,"

the internal conversation becomes:

"I have no reason to be struggling."

That distinction matters.

Feeling grateful and feeling overwhelmed can exist at the same time.

Asian American Mental Health: What the Research Actually Tells Us

Research on Asian American mental health is more complicated than simply saying that Asian Americans “don't seek therapy.”

A national study of Asian American adults found relatively low rates of mental health service use⁴, with meaningful differences based on birthplace and generation (Abe-Kim et al., 2007). U.S.-born Asian Americans reported higher service use than immigrant participants, and service use increased substantially among later-generation individuals with probable mental health diagnoses.

More recent research suggests that we also need to be careful about interpreting lower diagnosis rates as lower levels of distress.

A 2026 population-level study⁵ found that births to foreign-born Asian/Pacific Islander mothers had higher odds of a positive postpartum depression screen compared with White U.S.-born mothers, while simultaneously having lower odds of having that positive screen accompanied by a documented perinatal mental health diagnosis (Rokicki et al., 2026).

That distinction is important.

Someone can be experiencing significant symptoms without those symptoms becoming a formal diagnosis.

A screening tool can identify distress.

But the person still needs someone to ask what is happening, listen to the answer, and connect them with appropriate care.

This is one reason culturally responsive therapy matters.

Family Expectations Can Become More Complicated After Having a Baby

Having a child can change your relationship with your own parents.

Sometimes, the relationship becomes closer.

Sometimes, old tensions become much harder to ignore.

And sometimes, both happen at once.

You may suddenly find yourself negotiating:

How your baby should be fed
Sleep practices
Discipline
Grandparent involvement
Childcare
Family traditions
Language
Religion or spirituality
How often extended family should visit
What kind of parent you want to be

A parent might say:

"I appreciate everything my mom is doing, but I feel like I can't make my own decisions."
"I feel guilty setting boundaries."
"I don't want to disappoint my parents."

This can become particularly difficult when practical support and emotional pressure come from the same person.

You can genuinely appreciate someone's help and still need more boundaries.

You can love your family and still disagree with them.

You can understand why your parents parented the way they did without deciding that you need to parent exactly the same way.

Therapy can create room to explore those contradictions rather than forcing you to choose between loyalty and independence.

Perinatal Mental Health Is Also Shaped by Racism

Culturally responsive care needs to include more than family traditions.

For some Asian American parents, pregnancy and parenthood also occur alongside experiences of racism, stereotyping, discrimination, or feeling misunderstood within healthcare settings.

Recent research involving Asian birthing individuals found higher reported experiences of interpersonal racism⁶ compared with matched White participants (Tieu et al., 2026). The study also found that among Asian participants, the relationship between pandemic-related worries and postpartum anxiety was stronger among those reporting greater interpersonal racism.

This matters because stress does not exist in isolation.

A person may be navigating pregnancy, sleep deprivation, family expectations, and a new identity as a parent while also carrying experiences of being stereotyped or treated differently.

Culturally responsive therapy means being willing to ask about those experiences rather than assuming that family dynamics are the only cultural factor affecting someone's mental health.

Why Immigrant Experiences Matter

There is also a growing body of research examining the mental health of South and East Asian immigrant parents.

A 2026 systematic review of research⁷ involving South and East Asian immigrant pregnant women in high-income countries, including the United States, highlighted the burden of antenatal depression and anxiety while also identifying significant gaps in research and mental healthcare access (Obilor et al., 2026).

Immigration can bring its own forms of stress.

A parent may be raising a child in a cultural environment different from the one they grew up in.

They may be parenting without nearby extended family.

They may be navigating language differences.

They may feel caught between what their parents taught them and what they want for their own children.

For some, becoming a parent can bring previously unresolved questions about identity back to the surface:

"What parts of my childhood do I want to give my child?"
"What do I want to do differently?"
"How do I stay connected to my culture without repeating the parts that hurt me?"

These are not simple questions, and there is rarely one correct answer.

Sleep Deprivation Can Make Everything Feel Harder

Sleep disruption is part of early parenthood.

But chronic poor sleep can also interact with emotional health.

Research has found an association between poorer sleep quality and increased symptoms of depression and anxiety⁸ among postpartum women (Okun et al., 2018).

This can create a difficult cycle:

Anxiety makes it difficult to sleep.

Interrupted sleep increases emotional vulnerability.

Emotional exhaustion makes anxiety harder to manage.

Then the cycle starts again.

This is one reason perinatal mental health treatment should consider the practical realities of someone's life.

Telling an exhausted parent simply to “get more sleep” is rarely enough.

A more useful conversation might be:

Who can help?

What responsibilities can be shared?

Where can expectations be lowered?

What does the parent actually need?

Where is perfectionism making an already difficult situation harder?

What Does Culturally Responsive Therapy Look Like?

Culturally responsive therapy is not simply matching a client with an Asian therapist.

It means being curious about how culture, family, identity, immigration, relationships, and lived experiences shape the client's understanding of themselves.

For an Asian American parent, therapy might involve exploring:

Perinatal anxiety or depression
Intrusive thoughts
Perfectionism
Identity changes after becoming a parent
Family expectations
Intergenerational conflict
Boundaries with parents or in-laws
Attachment patterns
Relationship changes after childbirth
Racism or discrimination
Immigration-related stress
Guilt and self-criticism
Emotional regulation
The pressure to be a “good” parent

The goal is not to tell someone to reject their cultural values.

It is to help them determine what they genuinely value and what they may be carrying because they have learned that they are supposed to.

Sometimes therapy sounds like:

"Is this something you actually believe, or something you learned you were supposed to believe?"

That question can open up a lot.

When Should You Consider Therapy?

You do not have to wait until you are completely overwhelmed.

It may be worth talking with a mental health professional if:

Anxiety feels constant or difficult to control
You are having frequent panic attacks
You cannot sleep because your mind is racing
You feel persistently sad, numb, angry, or overwhelmed
Intrusive thoughts are taking up significant time
You are repeatedly checking or seeking reassurance
Guilt is affecting your ability to enjoy your life
Family conflict is becoming difficult to manage
You feel disconnected from your partner
You feel like you have lost your sense of identity
You are functioning on the outside but feel like you are barely holding things together internally

You also do not need to have a formal diagnosis before beginning therapy.

Sometimes the first step is simply being able to say:

"Something doesn't feel right, and I don't know what I need."

That is enough to start a conversation.

Screening Is a Starting Point, Not the Whole Answer

ACOG currently recommends standardized screening¹ for depression and anxiety throughout pregnancy and postpartum care, along with systems for assessment, treatment, and follow-up when someone screens positive.

This distinction is especially important for populations who may experience barriers to diagnosis or treatment.

A screening score is information.

It is not the whole story.

Someone may minimize symptoms because they feel guilty discussing them.

They may not recognize anxiety as a mental health concern.

They may worry about being judged.

They may not know that intrusive thoughts can occur with perinatal OCD.

They may have had a previous experience with therapy that felt culturally disconnected.

Culturally responsive care makes room for those factors.

Does Therapy Actually Help?

Yes.

Psychological treatments have demonstrated benefits for postpartum depression, with meta-analytic evidence supporting psychotherapy as an effective treatment approach⁸ (Cuijpers et al., 2008).

Current ACOG guidance¹⁰ also supports psychotherapy and other behavioral health interventions as part of treatment for perinatal mental health conditions, with medication considered when clinically appropriate. ACOG specifically recommends that treatment be accessible to pregnant and postpartum individuals and emphasizes ongoing monitoring.

Treatment does not have to mean choosing between being a good parent and taking care of yourself.

Your mental health is part of your family's well-being, too.

Common Questions About Asian American Perinatal Mental Health

Is it normal to feel anxious after having a baby?

Some worry and adjustment-related stress are common. But persistent or overwhelming anxiety, panic, intrusive thoughts, compulsive checking, or difficulty functioning can be signs that additional support would be helpful.

Can postpartum anxiety happen without postpartum depression?

Yes. Anxiety can occur on its own or alongside depression. A person does not need to feel sad all the time to be experiencing a significant perinatal mental health condition.

Can fathers and non-birthing parents experience perinatal mental health concerns?

Yes. The transition to parenthood can affect partners and non-birthing parents as well. Anxiety, depression, relationship stress, sleep disruption, and changes in identity can affect any parent.

Are intrusive thoughts about hurting my baby a sign that I am dangerous?

Not necessarily. Unwanted intrusive thoughts can occur with perinatal OCD and can be deeply distressing precisely because they conflict with someone's values. A qualified mental health professional can help assess what you are experiencing and distinguish intrusive thoughts from actual intent or risk.

If you are experiencing thoughts of harming yourself or someone else and are concerned about your immediate safety, seek urgent professional help rather than trying to manage the situation alone.

Do I need to have postpartum depression to start therapy?

No. Therapy can be useful for anxiety, perfectionism, family conflict, identity changes, relationship difficulties, intrusive thoughts, or simply feeling overwhelmed by the transition to parenthood.

Can I attend therapy virtually?

For clients who are physically located in Massachusetts, telehealth therapy can make accessing care more manageable during pregnancy and early parenthood. Individual therapy through Elephant Room Counseling is available only to clients physically located in Massachusetts because of professional licensing requirements.

Elephant Room Counseling also offers culturally responsive support groups for Asian and Asian American adults nationwide.

You Don't Have to Be Grateful Every Minute to Be a Good Parent

There is a particular kind of guilt that can emerge when you wanted something deeply and still find it difficult.

You can love your baby and miss your old life.

You can be grateful and exhausted.

You can appreciate your parents and need boundaries.

You can feel proud of your family and still struggle with anxiety.

You can want to honor your culture while making different choices from the generation before you.

None of these experiences cancel the others out.

Parenthood can bring joy and grief, connection and loneliness, gratitude and resentment, confidence and uncertainty.

Sometimes the most helpful thing therapy offers is not an answer to every question.

It is a place where you can finally say what you have been afraid to say out loud.

"I'm having a hard time."
"I don't know why I can't relax."
"I love my baby, but I'm not okay."
"I feel guilty setting boundaries."
"I want to do things differently, but I don't know how."

Those are important things to be able to say.

And you do not have to wait until things get worse before saying them.

Looking for an Asian Therapist in Massachusetts?

Elephant Room Counseling provides culturally responsive therapy for Asian and Asian American adults navigating anxiety, burnout, relationships, family expectations, identity, attachment, trauma, and perinatal mental health.

If you are physically located in Massachusetts, you can request an individual therapy appointment and explore whether working with an Asian therapist Massachusetts-based practice feels like a good fit for you.

We offer telehealth therapy throughout Massachusetts, making it possible to attend therapy from home during pregnancy, postpartum, or the busy years of parenting.

Adults across the United States are also welcome to learn more about our culturally responsive support groups for Asian and Asian American adults.

You do not have to figure everything out before reaching out.

Request an appointment

References

ACOG https://www.acog.org/programs/perinatal-mental-health/patient-screening
Wisner et al., 2013 https://pubmed.ncbi.nlm.nih.gov/23487258/
Khadka et al., 2024 https://pubmed.ncbi.nlm.nih.gov/39565621/
Abe-Kim et al., 2007 https://pubmed.ncbi.nlm.nih.gov/17138905/
Rokicki et al., 2026 https://pubmed.ncbi.nlm.nih.gov/42331041/
Tieu et al., 2026 https://pubmed.ncbi.nlm.nih.gov/42470608/
Obilor et al., 2026 https://pubmed.ncbi.nlm.nih.gov/42127571/
Okun et al., 2018 https://pubmed.ncbi.nlm.nih.gov/30030650/
Cuijpers et al., 2008 https://pubmed.ncbi.nlm.nih.gov/18161036/
ACOG https://www.acog.org/programs/perinatal-mental-health/assessment-and-treatment-of-perinatal-mental-health-conditions