Postpartum Depression is a type of depression that can occur in women who have recently given birth. It typically occurs in the first few months after delivery, but can happen within the first year after giving birth. Postpartum depression is different from the "Baby Blues", which tend to occur the first few days after delivery and resolve spontaneously.
After giving birth, about 70-80% of women experience an episode of baby blues, feelings of depression, anger, anxiety and guilt lasting for several days. About 10% of new mothers develop the more severe postpartum depression (also postnatal depression), a form of major depression for which treatment is widely recommended.
The diagnostic criteria for postpartum depression (PPD) are the same as that for major depression, except that to distinguish PPD from the baby (maternity) blues, the symptoms must be present past the second week postpartum.
Causes
While not all causes of PPD are known, several factors have been identified. Beck (2001) has conducted a meta-analysis of predictors of PPD. She found that the following 13 factors were significant predictors of PPD (effect size in parentheses -- larger values indicate larger effects):
* Prenatal depression, i.e., during pregnancy (.44 to .46)
* Low self esteem (.45 to.47)
* Childcare stress (.45 to .46)
* Prenatal anxiety (.41 to .45)
* Life stress (.38 to .40)
* Low social support (.36 to .41)
* Poor marital relationship (.38 to .39)
* History of previous depression (.38 to.39)
* Infant temperament problems/colic (.33 to .34)
* Maternity blues (.25 to .31)
* Single parent (.21 to .35)
* Low socioeconomic status (.19 to .22)
* Unplanned/unwanted pregnancy (.14 to .17)
These factors are known to correlate with PPD. That means that, e.g., high levels of prenatal depression are associated with high levels of postpartum depression, and low levels of prenatal depression are associated with low levels of postpartum depression. But this does not mean the prenatal depression causes postpartum depression -- they might both be caused by some third factor. In constrast, some factors, like lack of social support, almost certainly cause postpartum depression. (The causal role of lack of social support in PPD is strongly suggested by, e.g., O'Hara 1985, Field et al. 1985; and Gotlib et al. 1991.)
Although profound hormonal changes after childbirth are often claimed to cause PPD, there is little evidence that variation in pregnancy hormone levels is correlated with variation in PPD levels: Studies that have examined pregnancy hormone levels and PPD have usually failed to find a relationship (see, e.g., Harris 1994; O'Hara 1995). Further, fathers, who are not undergoing profound hormonal changes, suffer PPD at relatively high rates. Finally, all mothers experience these hormonal changes, yet only about 10-15% suffer PPD. This does not mean, however, that hormones do not play a role in PPD. Block et al (2000), for example, found that, in women with a history of PPD , a hormone treatment simulating pregnancy and parturition caused these women to suffer mood symptoms. The same treatment, however, did not cause mood symptoms in women with no history of PPD. One interpretation of these results is that there is a subgroup of women who are vulnerable to hormone changes during pregnancy. Another interpretation is that simulating a pregnancy will trigger PPD in women who are vulnerable to PPD for any of the reasons indicated by Beck's meta-analysis (summarized above).
Profound lifestyle changes brought about by caring for the infant are also frequently claimed to cause PPD, but, again, there is little evidence for this hypothesis. Mothers who have had several previous children without suffering PPD can nonetheless suffer it with their latest child. Plus, most women experience profound lifestyle changes with their first pregnancy, yet most do not suffer PPD.
In severe cases, postpartum psychosis (also known as puerperal psychosis) can develop, characterized by hallucinations and delusions. This happens in about 0.1 - 0.2% of all women after having given birth. In some cases, postpartum psychosis can develop independent of postpartum depression.
Sometimes a preexisting mental illness can be brought to the forefront through a postpartum depression.
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Postpartum depression".
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