Postpartum Depression

History

In 1968, Brice Pitt conducted the first large-scale longitudinal study assessing the mental health of 305 women during pregnancy and the postpartum period. His early prevalence estimate of 10.8% for major depression has held relatively constant over the years. In the 1970s, researchers studying the negative effects of maternal schizophrenia included children of depressed mothers as a control group. They unexpectedly discovered that both clinical groups performed equally poorly compared to children of mentally well women.

Diagnosis

The symptoms of depression include low mood and/or loss of interest, disturbed sleep, poor appetite, low energy, poor decision making and thinking, and the presence of suicidal feelings. In accordance with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR), the diagnostic criteria for a major depressive episode (MDD) include the presence of at least five symptoms, one of which must be either low mood or loss of interest. The symptoms must be present for a period of 2 weeks and represent a change in functioning. Minor depression is defined as the presence of two to four symptoms for a 2-week period. According to DSM-IV-TR, postpartum depression (PPD) is a descriptive term specifying the onset of MDD within the first 4 postpartum weeks. In clinical practice and research studies, PPD is typically applied to depression occurring any time within the first postpartum year.

Epidemiology

In 2005, a review of empirical evidence by the Agency for Healthcare Research and Quality indicated that depression affects as many as 18.4% of pregnant women (12.7% with MDD) and 19.2% (7.4% with MDD) of postpartum women. Risk factors include a family or personal history of emotional disorder (especially depression during pregnancy), the presence of stressful life events, poor social relationships (especially the marital relationship), and few financial resources.

Negative Effects

Depression compromises the well-being of all family members. In pregnancy, depressed women are more likely to use drugs, alcohol, and tobacco and have poor nutrition habits. After birth, depressed mothers interact less sensitively and more negatively with their newborns. They are less likely to use parenting practices to protect their infants, such as using electrical outlet coverings [Page 834]or car seats, and are more likely to physically abuse their children. The negative effects on children are apparent early on and persist through adolescence. Prenatal exposure to depression is associated with miscarriage, premature birth, and low birth weight. Newborns of depressed mothers display limited responsiveness on neurologic development scales, are fussier, vocalize less, and display fewer positive facial expressions. Toddlers and children of depressed mothers display more behavior problems, poorer cognitive functioning, and an increased incidence of psychiatric illnesses. Adolescents exposed to PPD as infants are more likely to be diagnosed with a depressive disorder than are teens of well mothers. Finally, partners of depressed women are at increased risk to experience depression.

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