Postpartum Depression

Diagnosis of PPD

Though the term postpartum depression is widely used by professionals and the public alike, no such diagnosis exists per se in major medical diagnostic systems. In the major medical diagnostic systems used worldwide, the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and the International Classification of Diseases 10th Edition, women may be assigned one of several depressive disorder diagnoses and given the qualifier of “postpartum onset.” Both diagnostic systems have been criticized for use with postpartum women on the grounds that too many of the symptoms are physically based and cannot be separated from the physical effects of childbirth and newborn care. Also, distinct subgroups of women with PPD symptoms appear to exist—anxious/depressive symptoms related to the psychological stress of infant care, trauma from labor and delivery experiences, problems relating to the newborn, and depression with psychotic features.

In the United States, women with a history of psychiatric diagnosis are greatest risk for PPD. Up to one-third of women with high-risk pregnancy (a label that is somewhat arbitrary) may experience severe PPD. Other risk factors include poverty, living in a densely populated urban area, exposure to violence, African or Mexican American ethnicity, and lone-parent status.

Many PPD experts view PPD as being based in the dramatic declines in female hormones occurring in the early postpartum period. Evidence for this perspective is mixed, though emerging data show that estrogen administration may have some preventive benefit. A physiological basis for postpartum psychosis seems more plausible given the relative rarity and unusual nature of associated symptoms.

Sociocultural Perspectives of PPD

From a sociocultural perspective, PPD comes about not from hormonal processes, but from powerful cultural forces that have defined and restricted women's social role to that of caregiver subordinate to male power. In cultures with so-called flexible gender roles, emphasis on the nuclear family and self-reliance leaves many new mothers isolated and with inadequate outside support for their around-the-clock caregiving responsibility. In this view, along with women's culturally imposed subordinate position in relationship to men, the very concept of “psychiatric disorder” is biased, in that male functioning is held as the standard to which women must be compared.

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