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PubMed2006

Postpartum depression: it isn't just the blues.

Postpartum depression is a crippling mood disorder, historically neglected in health care, leaving mothers to suffer in fear, confusion, and silence. Undiagnosed it can adversely affect the mother-infant relationship and lead to long-term emotional problems for the child. This article differentiates postpartum depression from other postpartum mood and anxiety disorders and addresses these aspects of postpartum depression: symptoms, prevalence, risk factors, interventions, and the effects on relationships and child development. Instruments available to screen for postpartum depression are also reviewed.

Antidepressive Agents↗
PubMed2006

Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms.

BACKGROUND: The prevalence of postpartum depression (PPD) is currently considered to be 10-15%. Most studies were performed with a brief unidimensional instruments (mostly the Edinburgh Postnatal Depression Scale-EPDS) with focus on depression and not on other symptoms and disorders. Most cited studies were conducted in Western economically developed countries. METHODS: We reviewed the literature on prevalence of postpartum depression and depressive symptoms in a wide range of countries. RESULTS: 143 studies were identified reporting prevalence in 40 countries. It is demonstrated that there is a wide range of reported prevalence of PPD ranging from almost 0% to almost 60%. In some countries like Singapore, Malta, Malaysia, Austria and Denmark there are very few reports of PPD or postpartum depressive symptoms, whereas in other countries (e.g. Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea) reported postpartum depressive symptoms are very prevalent. CONCLUSIONS: We believe that the widely cited mean prevalence of PPD-10-15% is not representative of the actual global prevalence and magnitude of the problem, due to the wide range of reports. The variability in reported PPD might be due to cross-cultural variables, reporting style, differences in perception of mental health and its stigma, differences in socio-economic environments (e.g. poverty, levels of social support or its perception, nutrition, stress), and biological vulnerability factors. The elucidation of the underlying processes of this variability as well as the diversity of postpartum normal versus abnormal expressions of symptoms may contribute to better understanding of the diversified ante, peri- and postpartum phenomena.

Cross-Cultural Comparison↗
PubMed2000

Transactional conflict between psychobiology and culture in the etiology of postpartum depression.

In vulnerable individuals, postpartum depression may be triggered by the disruption of neuropsychological processes during pregnancy and parturition. It is proposed that in Western societies pre- and postnatal psychological and instrumental needs are poorly met and this crisis may interact with neurophysiological factors in compromising maternal psychological functioning. The influence of developmental factors and psychological and physical stressors are discussed in relation to women's neuropsychological health during the peripartal transition. It is hypothesized that the environmental milieu may support, neglect or derail the mother's psychobiological transition from pregnancy to effective postnatal parenting and resumption of family and work roles.

Conflict, Psychological↗
PubMed2000

Transactional conflict between psychobiology and culture in the etiology of postpartum depression.

In vulnerable individuals, postpartum depression may be triggered by the disruption of neuropsychological processes during pregnancy and parturition. It is proposed that in Western societies pre- and postnatal psychological and instrumental needs are poorly met and this crisis may interact with neurophysiological factors in compromising maternal psychological functioning. The influence of developmental factors and psychological and physical stressors are discussed in relation to women's neuropsychological health during the peripartal transition. It is hypothesized that the environmental milieu may support, neglect or derail the mother's psychobiological transition from pregnancy to effective postnatal parenting and resumption of family and work roles.

Conflict, Psychological↗
PubMed1996

Postpartum depressive disorders.

Despite the high prevalence of postpartum depressive disorders, many signs and symptoms of this illness are dismissed as normal physiologic changes associated with childbirth. Prompt recognition and treatment are imperative in order to limit the negative impact on both the mother and infant. Mood disturbances may have a minor functional impact that respond well to social support (eg. postpartum blues) or cause significant functional compromise requiring more aggressive therapy (eg. postpartum depression). The most extreme case of postpartum depressive disorder, postpartum psychosis, occurs when patients develop psychosis, mania, or thoughts of infanticide. Depression during pregnancy or the presence of risk factors suggests the need for careful follow-up. If postpartum depression develops, psychotherapy is the first-line treatment. Antidepressant treatment may be warranted for some patients, and the risks and benefits to both the mother and infant should be considered in the decision to institute pharmacotherapy.

Antidepressive Agents↗
PubMed2002

Postpartum depressed women's explanation of depression.

PURPOSE: To gain empirically derived knowledge of postpartum depression upon which to base detection and intervention strategies. DESIGN: From 1997 through 2000, a sample of 30 nonhospitalized women, self-identified as postpartum depressed was recruited by network and "snowball sampling" to discuss their beliefs about postpartum depression. With reference to the Kleinman explanatory model of illness, their beliefs about postpartum depression and its treatment were contrasted to the biomedical model of postpartum depression. METHODS: Content analysis was done to classify data into cause, effect, severity, expectations, fears, and suggestions for treatment. Results were compared with DSM-IV diagnostic criteria. RESULTS: Postpartum depressed mothers' explanatory model of depression differed from the DSM-IV criteria for depression in that mothers' depiction was generally milder in form and consisted of sleep deprivation instead of sleep disorders. Also, mothers were confused, overwhelmed, and guilty about thoughts of hurting their babies. The mothers did not exhibit suicidal ideation. Mothers described the illness as severe and long lasting, causing multiple problems including marital discord. IMPLICATIONS: Mothers suggested more public education and support for new mothers to prevent and treat the disorder.

Adult↗
PubMed1986

Social support, infant temperament, and parenting self-efficacy: a mediational model of postpartum depression.

A model of maternal postpartum depression was tested in which difficult infant temperament was construed as a stressor and supportive interpersonal relationships were construed as a protective resource. It was hypothesized that both infant temperamental difficulty and level of social support would affect maternal depression through the cognitive mediation of perceived self-efficacy in the parenting role. Participants were 55 married women who were assessed during pregnancy and again 3 months postpartum. Infant temperament was assessed through observation, maternal crying records, and the Revised Infant Temperament Questionnaire. Results of a path analysis indicated that infant temperamental difficulty was strongly related to the mothers' level of postpartum depression, both directly and through the mediation of parenting self-efficacy. Consistent with predictions, social support appeared to exert its protective function against depression primarily through the mediation of self-efficacy. Both practical implications for identifying women at risk for postpartum depression and theoretical implications for understanding the mechanisms through which stressful events and social support affect adjustment are discussed.

Adult↗
PubMed1995

Using maternal representational patterns to evaluate postpartum depression.

This paper has reviewed postpartum depression through the use of a case history. As exemplified by the case, a key factor contributing to the onset of postpartum depression appears to be the caregiver's representations of her own experience with caregivers. In general, mothers whose representations of their childhood experience are positive appear psychologically equipped to transfer these emotions to the infant and to assume caregiving tasks with enthusiasm. In contrast, mothers whose representations of their caregiving experience are negative are apathetic about engaging the infant in interaction and hesitant about accepting the maternal role. While several etiologic factors have been linked to postpartum depression, representational deficits may provide a more comprehensive explanation of the origins of the disorder because such deficits encompass not only the mother's capacities, but also influence the interactional patterns mother exhibits with the infant. The case history describes a mother who represented a conflicted relationship with her own caregiver. Initially, her representations of her own mother were vague and unclear. Through inquiry, however, she gained access to her own experience--or, at least, to her representation of it--and began to understand how her own memories had negatively affected her ability to interact adaptively with her infant son. Treatment focused on three areas: Overcoming the mother's depressed affect; providing behavioral support for the infant's developmental efforts; and, re-invigorating the dyadic relationship. To accomplish these goals, the mother was taught observation techniques and intuitive behaviors. These techniques enabled her to view the infant in an objective fashion, devoid of distorted representations from her own childhood that reflected her attitude toward her caregiver. Helping the mother attain this new perspective enabled her to generate more adaptive representations, to acknowledge infant development more positively, and to initiate an adaptive dyadic exchange.

Adult↗
PubMed2003

The effect of social support and acculturation on postpartum depression in Mexican American women.

Postpartum depression was studied in 66 multiparous Mexican American women using a prospective longitudinal design. Interviews were conducted at 34 to 36 weeks prenatally and 4 to 6 weeks postpartum. Women expressing prenatal depression were more likely to continue to experience depression postpartum. Other predictors included a high need for postpartum support, specific support network characteristics, acculturation, and poor quality relationships within the family. It is important for the health care provider to assess the presence of depressive symptoms and available social support during the prenatal period and work with Mexican American mothers to increase support and secure help in dealing with daily life stressors.

Acculturation↗
PubMedDate not supplied

[A study of the Edinburgh Postnatal Depression Scale (EPDS) on 859 mothers: detection of mothers at risk for postpartum depression].

The postpartum is a high-risk period for the occurrence of anxious and depressive episodes. Indeed, during the first few days after delivery, mothers can present postpartum blues symptomatology: fatigue, anxiety, disordered sleeping and a changing mood. Postpartum depression is characterised by a changing mood, anxiety, irritability, depression, panic and obsessional phenomena. It occurs in approximately 10 to 20% mothers. The exact prevalence depending on the criteria used for detection. The first symptoms usually appear between the fourth and sixth week postpartum. However, postpartum depression can start from the moment of birth, or may result from depression evolving continuously since pregnancy. We can add that the intensity of postpartum blues is a risk factor that can perturb maternal development. So it is important for health professionals to dispose of predictive tools. This study is a validation of the French version of the EPDS. The aims of the study were to evaluate the postpartum depression predictive value at 3 days postpartum and to determine a cut-off score for major depression. Subjects participating in this study were met in 3 obstetrical clinics in, or in the vicinity of, Toulouse. Mothers with psychological problems, under treatment for psychological problems or mothers whose babies present serious health problems were excluded from the study. The EPDS was presented to 859 mothers (mean age=30.3; SD=4.5) met at one of the clinics at 3 days postpartum (period 1). They had an EPDS mean score of 6.4 (SD=4.6); 258 (30%) mothers had an EPDS score 9. 82.6% of these mothers experienced a natural childbirth and 17.3% a caesarean section; 51.5% gave birth to their first child, 36.2% to their second child and 12.3% to their third or more. All subjects were given a second EPDS with written instructions to complete the scale during the period 4 to 6 weeks postpartum and return it for analysis (period 2). Between the 4 to 6 weeks postpartum period, 722 mothers replied again to the EPDS. 131 mothers had an EPDS score 11 (mean age=30.3; SD=4.8). They had an EPDS mean score of 13.6 (SD=3.3). Mothers with probable depression were interviewed and assessed, using the Mini (Mini Neuropsychiatric Interview, Lecrubier et al. 1997), the SIGH-D (Structured Interview Guide for the Hamilton Depression Scale) and the BDI (Beck Depression Inventory) in order to diagnose a major depressive episode. They had a HDRS mean score of 13.7 (SD=5.1) and a BDI mean score of 13.6 (SD=5). At 3 days postpartum, we observed that 258 mothers (30%) had an EPDS scores 9 and 164 mothers (19%) had an EPDS scores 11. Between 4 and 6 weeks postpartum, we observed 18.1% of postpartum depression (EPDS 11) and 16.8% (EPDS 12) of major postpartum depression. The analysis of the sensitivity and the specificity at 3 days postpartum provides a cut-off score of 9 (Sensibility: 0.88) (Specificity: 0.50) as predictive of postpartum depression, for this cut-off score, the type I error is low (5.8%) but the type II error is more higher (18.9%). The analysis of the sensitivity and the specificity between 4 and 6 weeks postpartum provides a cut-off score of 12 (Sensibility: 0.91) (Sensibility: 0.74) for the detection of major postpartum depression. Factor analysis shows at 3 days postpartum that the internal structure of the scale is composed of two subscales. The first factor F1 "anxiety" accounts 28% of the variance and the second factor F2 "depression" accounts 20% of the variance. Between 4 and 6 weeks postpartum, factor analysis suggests an unidimensional model in the evaluation of postpartum depression which is better than a two factor model. This factor accounts 40% of the variance. The scale has a good predictive value, and we can observe a significant correlation with the EPDS periods 1 and 2 (r=0.56; p<0.05). This result shows that the depressive mothers mood intensity predicts a future depressive risk. Furthermore, correlations between EPDS and BDI (r=0.68; p<0.05) and EPDS and HDRS (r=0.67; p<0.05) show a good convergent validity. The reliability study confirms the good internal consistency of the EPDS, at 3 days postpartum and in the postpartum depression -symptomatology evaluation (Cronbach's Alpha>0.80). In conclusion, this scale demonstrates good validity and is fast and easy use in obstetrical services, allowing early detection of women who risk to develop postpartum depression and, in the first week of postpartum, of mothers who suffer from a major postpartum depression. The use of the EPDS for an early screening of the risk of postnatal depression which is essential considering the consequences that postnatal depression can have on the development of the infant, on the quality of the relationship within the couple and on other social relationships. Mothers at risk for postnatal depression should be controlled and surveyed by the health professionals in obstetrical clinics.

Adult↗
PubMed2006

Temperament and character in women with postpartum depression.

OBJECTIVE: To investigate whether women with postpartum depression differ in personality traits from healthy postpartum women, healthy controls from the normal Swedish population and non-postpartum women with major depression. METHODS: Forty-five women with postpartum depression were compared with 62 healthy postpartum women, 62 age-matched, healthy, non-postpartum women from a normal sample and 74 non-postpartum women with major depression from a clinical sample. The edinburgh postnatal depression scale was used in order to screen for postpartum depression. A clinical diagnostic interview was done including a rating with the Montgomery-Asberg depression rating scale. Personality i.e. temperament and character was measured by the temperament and character inventory. RESULTS: Harm avoidance (HA) was higher (p < 0.001) and self-directedness (SD) scored lower (p < 0.001) in women with postpartum depression compared to healthy postpartum women. These differences were the most important differences between these two groups. Women with postpartum depression scored lower (p = 0.001) in cooperativeness (CO) and higher (p = 0.019) in self-transcendence (ST) compared to healthy postpartum women. Women with postpartum depression scored overall similar to women with major depression. CONCLUSION: High HA and low SD can be seen as vulnerability factors for developing a depression and especially in a stressful situation as childbirth.

Adult↗
PubMedDate not supplied

The many faces of postpartum depression.

OBJECTIVE: To provide a profile of women suffering from major postpartum depression as assessed by the Postpartum Depression Screening Scale (PDSS). DESIGN: A secondary analysis conducted on a portion of the data collected from an earlier psychometric testing of the PDSS. SETTING: Private practice in the San Francisco Bay Area of a marriage and family therapist specializing in perinatal mood disorders. PARTICIPANTS: One hundred thirty-three women who were diagnosed with major postpartum depression. INTERVENTION: Each mother completed the PDSS followed by a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnostic interview. MAIN OUTCOME MEASURE: Seven dimensions of postpartum depression: sleeping/eating disturbances, anxiety/insecurity, emotional lability, mental confusion, loss of self, guilt/shame, and suicidal thoughts as measured by the PDSS. RESULTS: Scores on all seven dimensions of the PDSS were elevated. The three top dimensions were emotional lability, mental confusion, and anxiety/insecurity. The mean total PDSS score of 120 was well beyond the recommended cutoff score of 80 for a positive screen for major postpartum depression. CONCLUSION: Clinicians who come in contact with new mothers need to be alert to the range of possible symptoms that postpartum depressed mothers may experience so that these women are not left to suffer in silence.

Adult↗
PubMed2004

A review of postpartum depression for the primary care physician.

Postpartum depression (PPD) occurs more commonly in U.S. women than most physicians realize. PPD is present in at least 10% and up to 20% of women in the United States within the first 6 months of delivery. The rate may be 25% or higher in women with a history of postpartum depression after a previous delivery. Over half of all women who develop postpartum depression still suffer symptoms a year later. This condition causes tremendous morbidity in terms of suffering and decreased quality of life. As with other psychiatric disorders, patients with PPD are more likely to seek help from their primary care doctors than from mental health professionals. Therefore, these providers should be equipped with the knowledge and tools necessary to properly care for women with PPD.

Depression, Postpartum↗
PubMed2005

Racial and ethnic differences in factors associated with early postpartum depressive symptoms.

OBJECTIVE: To explore racial differences in reporting of early postpartum depressive symptoms. To explore whether racial differences in early postpartum experience (such as mother's health status and social context) might account for racial differences in reported postpartum depressive symptoms. METHODS: This was a telephone survey of 655 white, African-American, and Hispanic mothers between 2 and 6 weeks postpartum. Mothers reported on demographic factors, physical symptoms, daily function, infant behaviors, social support, skills in managing infant and household, access, and trust in the medical system. We explored racial differences in report of early postpartum depressive symptoms using bivariate and multivariate statistics. RESULTS: African-American and Hispanic women more commonly reported postpartum depressive symptoms (43.9% and 46.8%, respectively) than white women (31.3%, P < .001). Similar factors (physical symptom burden, lack of social support, and lack of self-efficacy) were associated with early postpartum depressive symptoms in white, African-American, and Hispanic mothers. In a comprehensive model including other demographic factors, history of depression, physical symptoms, daily function, infant behavior, social support, skills in managing infant and household, access, and trust, the adjusted odds ratio for reported postpartum depressive symptoms remained elevated for African-American women at 2.16 (95% confidence interval 1.26-3.70) and Hispanic women at 1.89 (95% confidence interval 1.19-3.01) as compared with white women. CONCLUSION: African-American and Hispanic mothers are at higher risk for reporting early postpartum depressive symptoms as compared with white mothers. Factors associated with these symptoms are similar among African-American, Hispanic, and white mothers.

Adult↗
PubMed1994

Postpartum depression: how much do obstetric nurses and obstetricians know?

Postpartum depression affects 10 to 15 percent of all mothers. A study of 725 obstetric nurses and 204 obstetricians was conducted using a reliable two-factor scale to measure their knowledge and awareness of postpartum depression. Nurses were more aware than physicians of the emotional impact of postpartum depression. Nurses who demonstrated more empathy and who believed education of postpartum depression does not increase a mother's risk were more aware of the postpartum phenomenon than nurses who were less empathic and who did not hold the same belief. Younger and women physicians recognized the psychosocial antecedents to postpartum depression to a greater degree than did older and men physicians. These findings offer potential use in the training of perinatal health care professionals and in the education of pregnant women about postpartum depression.

Adult↗
PubMed1998

[Postpartum depression].

UNLABELLED: We investigated whether informing first-time mothers about postpartum depression affects their experience and behaviour during the depression occurring in the first two weeks after birth. METHOD: 138 first-time mothers who were participants in a longitudinal study sponsored by the Swiss National Fund were retrospectively surveyed concerning postpartum depression in the week after birth (response rate: 86.9%). RESULTS: 90% of the new mothers were affected. One fourth reported severe to very severe symptoms. The most popular sources of information about postpartum depression were books (65.8%) and magazines (59.2%). 10% of the mothers received information from their gynaecologist. 33% of the mothers with severe to very severe symptoms reported that after the birth no member of the medical or paramedical professions had discussed postpartum depression with them. Among the mothers who knew about postpartum depression, 30% did not feel adequately prepared for the degree of depression. Comparisons between informed and non-informed mothers show that the informed mothers had fewer symptoms, a shorter duration, and suffered less. In addition, the following reactions were noted: the informed mothers complained less and were less likely to believe that they were alone in their suffering. Also, they tended to have less negative thought patterns, felt less powerless, and were better able to explain their feelings and behaviour. RECOMMENDATIONS: Information about postpartum depression, especially to ensure that new mothers "feel prepared for it", has a positive influence on experience and behaviour in the week after birth. Therefore, it is useful to inform women about postpartum depression before the birth. This could be integrated into the neonatal care programme offered by the woman's gynaecologist. At the same time, training for nursing staff concerning postpartum depression is recommended.

Adolescent↗
PubMed2000

Postpartum depression: a comparison of screening and routine clinical evaluation.

OBJECTIVE: This study compared the efficacy of routine clinical evaluation with that of screening with the Edinburgh Postnatal Depression Scale for the detection of postpartum depression in a residency training program practice. STUDY DESIGN: Three hundred ninety-one patients during a period of 1 year were assigned according to delivery date to screening for postpartum depression with the Edinburgh Postnatal Depression Scale or to a control group who had only spontaneous detection during routine clinical evaluation. The incidences of postpartum depression detection and demographic characteristics were compared between 79 patients in the Edinburgh Postnatal Depression Scale group and 96 patients in the clinical evaluation group by means of chi(2) analyses. RESULTS: The incidence of postpartum depression detection with the Edinburgh Postnatal Depression Scale was significantly higher than the incidence of spontaneous detection during routine clinical evaluation (35.4% and 6.3%, respectively; P =.001). CONCLUSIONS: The Edinburgh Postnatal Depression Scale is an effective adjunct to clinical interview for diagnosis of postpartum depression and should be considered in residency training.

Adult↗
PubMed1995

Etiology of postpartum depression--a review.

The literature on the etiology of postpartum depression was explored, including demographic, gynecologic-obstetric, biological, psychopathological, cognitive-behavioral, sociocultural and psychosocial factors. Prevailing views about the causation of postpartum depression reflect a multifactorial theory in which all of the selected factors contribute. Empirically derived evidence in support of such a theory is, however, not yet readily available. The emphasis in investigative work regarding the etiology of postpartum depression now appears to be in the psychosocial areas. The underlying assumption from a psychosocial perspective is that postpartum depression results from the stress of the peripartum period and adjustments to child-care responsibilities. In Taiwan, Chen (1994) confirmed the basic Postpartum Depression Model, supporting the predicted relationships between perceived stress, social support, self-esteem and postpartum depression. This model can be incorporated into the nursing body of knowledge. Based on this predictive theory, scientifically valid nursing interventions can be developed and tested.

Depression↗