While we are becoming more attentive to screening for depressive symptoms during pregnancy and the postpartum period, we may not always ask about a history of trauma, especially when a woman has had what most would consider an “uncomplicated” pregnancy. A recent study, however, indicates that a history of trauma may be a risk factor for depression during pregnancy.
Postpartum depression (PPD) is a relatively common problem, affecting between 10% and 15% of women after delivery. Although it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women who are more vulnerable. One such group is teen mothers, where the risk of PPD is about 25%.
Many studies have demonstrated an increased risk for depression among the children of mothers with depression. Exactly how this vulnerability to depression is transmitted to the child is not precisely understood. Genetic factors clearly play an important role, but there are other important factors which contribute to the intergenerational transmission of depression. For example, many studies have shown that postpartum depression may contribute to parenting styles which increase a child’s likelihood of developing depression later on. While the child appears to be particularly sensitive to the effects of maternal depression during the first year of life, it appears that older children are also affected by maternal depression and are more likely to suffer from depression and other psychiatric symptoms than children with non-depressed mothers.
In an excellent and thoughtful review article, Kristina Deligiannidis and Marlene Freeman (from the MGH Center for Women’s Mental Health) summarize data on the efficacy of complementary and alternative medicine therapies for the treatment of perinatal depression. This is one of the most thorough reviews on CAM and provides thoughtful, evidence-based recommendations regarding the use of these treatments for women with perinatal depression. It is definitely worth tracking down a copy of this review, but if you can’t find it, here is a summary.
Various screening tools have been used to identify women with postpartum depression (PPD. The most widely used self-report tools for detection of PPD are the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory (BDI) having ten and 21 items, respectively. However, the EPDS and the BDI may be too lengthy to use for quickly screening patients in obstetric, primary care, or pediatric settings.
Women with premenstrual symptoms (PMS) and premenstrual dysphoric disorder experience symptoms during the premenstrual phase of their cycles. Because levels of estrogen and progesterone do not differ significantly between women with PMS and those without, it has long been hypothesized that PMS/PMDD represents an abnormal response to normal hormonal fluctuations (Schmidt et al, 1998).
Having a newborn child to the neonatal intensive care unit (NICU) is stressful to parents. It would be easy to imagine that in this environment, women may be more vulnerable to postpartum depression (PPD). A recent study assessed the incidence of PPD in a total of 131 mothers with infant admitted to the NICU.
We write often here about the negative effects of postpartum depression on the child. Most of the studies thus far have focused on behavior and cognitive development; a recent study from researchers at JohnsHopkinsUniversity suggests that being exposed to maternal depression during the first year of life may negatively affect the physical development of the child as well.
Postpartum psychosis is a rare but serious psychiatric illness, occurring in about 1 to 2 per 1000 women after delivery. Because postpartum psychosis carries significant risks for both the mother and her child, most women with this illness are psychiatrically hospitalized. Electroconvulsive therapy (ECT) is an effective treatment for postpartum psychosis and may reduce the risks associated with medication exposure in the nursing infant; however, very few research studies have focused on the use of ECT in this setting and it is less commonly used in the United States than in other countries. A recent study explores the safety and advantages of ECT for the treatment of women hospitalized for postpartum psychosis.
For women the postpartum period is a time of increased vulnerability to mood disorders. Recent estimates indicate that about 20% of women will suffer from significant depressive symptoms during the year after the birth of a child. Despite a significant push over the last decade to identify and effectively treat women with mood disorders during pregnancy and the postpartum period, treatment rates in this population remain unacceptably low. Furthermore, questions still remain regarding the optimal timing of screening and the best instruments to be used in this setting.
