Postpartum
Postpartum depression is frequent and involves the woman, baby, and family. Treatment is based on the degree of symptoms and the level of functional impairment and may include social support, psychological counseling, and pharmacotherapy typically an SSRI as first-line therapy.
They occur in up to 15% of mothers. Numerous psychosocial and biological risk factors for PPD have been identified according to recent research. The adverse short and long-term effects on child development are well documented. More research is required to study systematically the short- and long-term consequences of exposure to medication via breastmilk on infant and child development.
Onset of Postpartum Depression
Diagnostic criteria of the American Psychiatric Association include maternal postpartum mood disorder onset within 4 weeks postpartum and literature not covered in this review suggests that onset of postpartum depression typically occurs within the first 3 to 4 weeks postpartum. Nine studies examined reported data on the onset of depressive symptoms following childbirth. For most women, the onset of postpartum depression typically happens in the first few weeks or months following delivery. For others, onset was delayed, even several months later.
During the 5 weeks following childbirth in a two-step screening process by the Edinburgh Postnatal Depression Scale the prevalence of depression was 3 times as high as among nonpostpartum women the study found that in 71% of ill women, depression had its origins within the first 4 weeks postpartum but in 5.3% of women, depression arose after the third month.
In a study nearly 50% of ill women started getting depressed within 3 months after childbirth, whereas nearly a third developed depression with a later timing. Cooper, Campbell, Day, and Kennerley (1988) also found in their study that nearly half the cases of known nonpsychotic postpartum psychiatric disorders commenced within 3 months of the time of delivery. Yet, Cooper et al. discovered that a further 25% of women experienced onset of depression between 6 and 12 months after delivery.
Research on postpartum
Kumar and Robson (1984) stated that 16 of the women in their sample became depressed in the first 3 months after delivery, 5 became depressed at 3 to 6 months after delivery, 5 became. The frequency and potential duration of postpartum depression are important because symptoms of depression have been linked with serious adverse effects on women and their families. depressed 6 to 12 months postpartum, and 3 more became depressed 1 to 4 years after delivery.
Later postpartum onset of depression was described in three additional studies as well. In these investigations where onset was explicitly mentioned, it was noted that while for the majority of women depression started during the initial weeks or months after giving birth, for some women onset was later during the first year after giving birth. Prevalence of Depression at 6 Months Postpartum
In one study of women in Portugal, nearly half the women who were depressed at 3 months postpartum remained depressed 4 to 12 months later.
In other research, 30% to 54% of women depressed at previous postpartum assessment were still depressed at 6 months postpartum. In community samples, maternal depression at 6 months postpartum has had a point prevalence ranging from 9.1% to 38.2%. Findings in a community-based longitudinal study of 1,558 postpartum women in Sweden showed a prevalence rate of depression to be 13% at 6 to 8 weeks postpartum using the EPDS. At 6 months postpartum, the same prevalence rate of 13% was observed, indicating constant postpartum depression rates for the first 6 months after delivery.
Prevalence of Depression
6 to 12 Months Postpartum
In a cohort of 9,028 women in the Avon Longitudinal Study 8.1% had probable clinical depression by
scoring 13 or more on the EPDS at 8 months postpartum. In a population study of 791 women in Australia at 8 to 9 months postpartum 15.4% had scores of 13 or more on the EPDS.
Comparable rates were identified by Hiscock and Wake 2001, with 15% of women obtaining 13 or more on the EPDS at 6 to 12 months postpartum.
In addition, an additional 18% of the same sample obtained in the low depressed range 10 to 12 on the EPDS, suggesting that in addition to high depressive symptomatology in women, considerable numbers of women had subclinical levels of depressive symptomatology. Matthey, Barnett, Ungerer, and Waters 2000 gave the rate of women with depression at 1 year postpartum in a community sample as 12.4%. When McIntosh 1993 employed a wide definition of depression, he found that 63% of women researched had experienced depression at some point during the 9 months after giving birth.
In addition depressive episodes were not short-lived 69% lasted over 3 months and 47% lasted 7 or more months.
These findings suggest that postpartum depressive symptoms and postpartum depression are a continued issue for many women well into the second part of the first year following birth. Period Prevalence of Depression During
The first 12 Months Postpartum
The period prevalence, or the proportion of women who have had depressive symptoms at some time during the first year after delivery, is an additional indicator of the prevalence of postpartum depression. Period prevalence of postpartum depression in the first year following delivery has been shown to be 24% and 27.3%. A study of first-time
Portuguese mothers, up to 49% of the women in a sample had experienced postpartum depression at least once during the first year, as defined by research diagnostic criteria from Schedule for Affective Disorders and Schizophrenia interviews. This suggests that a high proportion of women suffer from depressive symptoms in the first year following childbirth.
There is strong evidence that postpartum women are at higher risk for psychosis and mild dysphoria.
There is, however, limited evidence that the postpartum period is a period of increased risk of developing non-psychotic depression. There are some prospective studies that have identified an increase in depression during the postpartum period.
Other more recent research with larger study groups has evidenced lower scores of depression in the postpartum phase compared with the women during late pregnancy. To our knowledge, only three studies have had a control group of nonpostpartum women from the same sample for comparison. If postpartum women are at higher risk for depression, it would be expected that the incidence of depression among postpartum women is greater than in the overall population after adjusting for other depression-associated factors.