Postpartum depression: A must read for all moms

Pregnancy comes with a lot of changes. Aside from the physical changes, it comes with emotional implications for women, including mood disorders such as postpartum depression(PPD). According to studies, PPD affects 10-15 percent of mothers yearly.

What is postpartum depression?

Postpartum depression is an episode of non-psychotic depression according to standardised diagnostic criteria with onset within 1 year of childbirth. In general, depression is a major public health problem that is twice as common in women as men during the childbearing years.

How a mother can know she is having postpartum depression?

After pregnancy, you may experience changes that are normal and similar to those of depression. However, should the following symptoms of depression last for more than two weeks, you may want to call your doctor, nurse, or midwife:

Feelings of restlessness or moodyFeeling sad, hopeless, or overwhelmedCrying a lotHaving thoughts of hurting the babyHaving thoughts of hurting yourselfNot having any interest in the baby, not feeling connected to the baby, or feeling as if your baby is someone else’s babyHaving no energy or motivationEating too little or too muchSleeping too little or too muchHaving trouble focusing or making decisionsHaving memory problemsFeeling worthless, guilty, or like a bad motherLosing interest or pleasure in activities you used to enjoyWithdrawing from friends and familyHaving headaches, aches and pains, or stomach problems that don’t go away.

Sometimes you may not tell anyone about your symptoms because you feel embarrassed, ashamed, or guilty about feeling depressed when you are supposed to be happy. You may also worry that you will be perceived as bad mother. The thing is, any woman can become depressed during pregnancy or after having a baby.

However, you and your baby don’t have to suffer. There is help. Your doctor can help you figure out whether your symptoms are caused by depression or something else.

What are the risk factors?

According research studies, the following risk factors are strong predictors of postpartum depression:

Depression or anxiety during pregnancyStressful recent life eventsPoor social supportPrevious history of depression

Moderate predictors of postpartum depression are:

Childcare stressLow self-esteemMaternal neuroticism(irrational and drastic reactions)Difficult infant temperament

Small predictors include:

Obstetric and pregnancy complicationsNegative cognitive attributionsSingle marital statusPoor relationship with partnerLower socioeconomic status, including income.

There is no relationship found for ethnicity, maternal age, level of education, parity, or gender of child.

Detection, prevention and treatment

While postpartum depression is a major health issue for many women from diverse cultures, this condition often remains undiagnosed. And although several measures have been created to detect depressive symptoms in women who have recently given birth, the development of a postpartum depression screening program requires careful consideration.

Evidence-based decisions need to be made regarding: the most effective screening test that not only has good sensitivity and specificity, but is quick, easy to interpret, readily incorporated into practice, and culturally sensitive; and health care system issues such as cost-effectiveness, potential harm, and policies for referral. Fortunately, preliminary research suggests postpartum depression is amenable to treatment interventions thus providing a rationale for the development of a screening program.

One certainty is that there is no single etiological pathway/cause by which women develop postpartum depression, thus it is unlikely that a single preventive treatment will be effective for all women.

Effects on the mother-infant relationship and child growth and development

Current research suggests that postpartum depression has major but selective effects on the mother-infant relationship, child growth and development. Young children of mothers with postpartum depression have greater cognitive, behavioural, and interpersonal problems than children of non-depressed mothers.

With regard to emotional growth and development, studies support an early effect of postpartum depression on infants, but do not support longer effects. Overall, it is exposure to prolonged episodes of postpartum depression or to recurrent episodes of maternal depression that are most likely to have long term effects on the child.

Public health interventions and strategies

Unfortunately, there are few studies of public health interventions that can prevent or mitigate the impact of postpartum depression on these outcomes.

A few studies, of variable quality, have explored the impact of interventions such as home visiting, telephone counseling, interactive coaching, group interventions, and massage therapy.

The results of these studies are still very preliminary and must be interpreted with caution. Large, well-controlled longitudinal studies that specifically measure maternal-infant relations and child development are required.