![By Vera Kratochvil [Public domain], via Wikimedia Commons](https://womensmentalhealth.org/wp-content/uploads/2015/06/Mother_Kissing_Baby-320x202.jpg)
Meet Christine. She is a married 30-year-old woman who just had her first baby about 3 weeks ago. While the pregnancy went smoothly, the experience of labor and delivery was difficult. After nearly 20 hours [...]
There is a growing body of literature which indicates that anxiety symptoms are common during pregnancy and the postpartum period. Anxiety during pregnancy places the woman at greater risk for postpartum depression and may also [...]
A recent study followed 29 mothers who gave birth to 35 premature children born before the 33rd week of pregnancy. The women were assessed within 2 weeks postpartum (T0), 2 weeks after hospitalization (T1), 6 months post-term (T2), and 18 months post-term (T3). The Impact of Event Scale (IES), General Health Questionnaire (GHQ) and State Anxiety Inventory (STAI-X1) were used to assess maternal mental health outcomes.
This week in the New York Times, there is a two-part story on maternal mental illness. Highlighting the experience of two women who became ill during the postpartum period, the articles focus on the range of disorders which can emerge during the postpartum period -- not only depression, but bipolar disorder, anxiety, OCD, and psychosis.
While postpartum depression (PPD) affects about 10%-15% of women, most women with PPD do not receive any treatment. Over the last decade, we have made progress in increasing awareness of postpartum mental health issues; however, there are still significant obstacles to obtaining treatment. Women are not able to find appropriate treaters or cannot access care in a timely fashion, especially in more remote areas. They may not have reliable childcare and thus cannot attend their own appointments. Or they may simply be too depressed or anxious to leave their homes.
Pregnancy loss may cause great psychological stress for women. How such a loss, whether or not the woman identifies it as a stressor, affects her emotional well-being after the birth of a future child is unknown. In order to better understand the relationship between pregnancy loss and risk for postpartum psychiatric illness, researchers assessed 192 women at their first-year pediatric well-child care visits in an urban pediatric clinic. In this group of low income mothers, 49% of the women reported a previous pregnancy loss (miscarriage, stillbirth, or induced abortion).
The Edinburgh Postnatal Depression Scale (EPDS) was designed to screen women for postnatal depression. Cox and Holden (2003) state that the EPDS was not designed to measure anxiety. However, recent emphasis on the importance of recognizing symptoms of perinatal anxiety disorders, coupled with findings in research, have led to the suggestion that the EPDS may be used as a multidimensional tool to screen for anxiety disorders in addition to depression during the perinatal period (Matthey et al, 2012).
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.
