While much attention has focused on the impact of maternal psychiatric illness on the well-being of the child, less is known about the impact of psychiatric illness in the father. A large population-based study from Norway examines the association between symptoms of psychological distress in expectant fathers and socioemotional and behavioral outcomes in their children at 36 months of age.
In our weekly clinical rounds, we recently discussed how motherhood is such a unique and personal experience for each woman. Often it is assumed that this transition into a new role is easy when for many it is not. How we assess a woman's experiences during the postpartum period is often limited to just her mood. I recently came across a new self-report instrument, The Being a Mother Scale (BaM-13) developed by Stephen Matthey which attempts to assess the “wider domain of the woman’s experience of motherhood” rather than just the presence or absence of a postpartum mood disorder.
While most agree that there is a need for improved detection of anxiety and mood disorders in pregnant and postpartum women, there remain questions regarding the best instruments to use for screening. The Edinburgh Postnatal Depression Scale (a questionnaire consisting of 10 items) has long been used to screen women for postpartum depression (PPD); however, it is unclear how well these questions could be incorporated into larger surveillance programs, such as the CDC-sponsored Pregnancy Risk Assessment Monitoring System (PRAMS) which was designed to assess health behaviors and to screen for health problems, including depression and anxiety, in pregnant and postpartum women.
In our clinic, we often see women who come in for the treatment of depression and/or anxiety after the cessation of breastfeeding. Many question if breastfeeding may protect against postpartum depression and if the cessation of breastfeeding is a trigger for postpartum depression and/or anxiety. However, the research examining the association between postpartum depression and breastfeeding has been somewhat difficult to interpret.
While much research has demonstrated that maternal depression may negatively affect the child, leading to increased risk of developmental delays, behavioral problems, and psychiatric illness. Less research, however, has detailed the impact of paternal depression; several recent studies have focused on better understanding the risk factors for paternal depression and how paternal depression affects children.
Multiple studies have demonstrated that childhood maltreatment is associated with subsequent difficulties. Researchers from the University of Michigan assessed parenting behaviors in women with a history of childhood abuse and neglect (n?=?97) and a healthy control comparison group (n?=?53). Participants were assessed at 6 weeks, 4 months, and 6 months postpartum. At 6 months, a home visit was conducted and mothers and infants participated in a dyadic play interaction later coded for positive parenting behaviors by blinded raters.
In 2009, the Australian government launched the National Perinatal Depression Initiative (NPDI) in order “to improve the prevention and early detection of antenatal and postnatal depression and to provide better support and treatment for expectant and new mothers experiencing depression.” Its scope is very much like the MOTHERS Act, which became law in the United States in 2010. Both initiatives seek to increase public awareness of perinatal depression, to provide support and treatment for pregnant and postpartum women with depression, to fund research in this area, and to implement training of health care professionals.
About 10-30% of children have functional somatic symptoms (FSS). These are physical complaints, such as headaches, pain, fatigue, and dizziness, that cannot be explained medically. A new study suggests that when a child is exposed to depression or anxiety in the mother during the first year of life, he or she is more likely to report these somatic symptoms later on.
This is a small case report but is an important one, demonstrating the effectiveness of ultra-brief electroconvulsive therapy (ECT) for the treatment of severe postpartum depression. While most women with postpartum illness have mild to moderate illness, there are some women with severe depression that significantly impairs their ability to function and to care for their child. Women with severe PPD are also at higher risk for suicide.
A recent study from McGill University has assessed the prevalence and course of Post-Traumatic Stress Disorder (PTSD) following childbirth. The sample included 308 women who were assessed at four time points: 25-40 weeks gestation, 4-6 weeks postpartum, 3 and 6 months postpartum. Current and prior PTSD were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) and the Modified PTSD Symptom Scale Self-Report (MPSS-SR).
