Postpartum Depression (PPD)

Postpartum depression ( Post Natal to you and me) is a complex mix of physical, emotional, and behavioural changes that occur in a mother after giving birth. It is a serious condition, affecting 10% of new mothers. Symptoms range from mild to severe depression and may appear within days of delivery or gradually, perhaps up to a year later. Symptoms may last from a few weeks to a year.
Baby blues

'Baby' or maternity blues are a mild and transitory form of 'moodiness' suffered by up to 80% of postpartum women. Symptoms typically last from a few hours to several days, and include tearfulness, irritability, hypochondriasis, sleeplessness, impairment of concentration, and headache. The maternity blues are not considered a postpartum depressive disorder.

Diagnosis
The diagnostic criteria for postpartum depression (PPD) are the same as for major depression, except that to distinguish PPD from the mild, transitory baby (maternity) blues, the symptoms must be present one month postpartum. Depression can also occur during pregnancy (ante-natal depression).

There are other types of postpartum distress that do not involve depression. For example, the mother may present with postpartum anxiety and postpartum OCD (including pure-O OCD). Symptoms of post-partum OCD include recurring intrusive thoughts, obsessive thoughts, avoidance behavior, fears, anxiety, and depression.

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, for example, 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 contrast, some factors, such as lack of social support, almost certainly cause postpartum depression. (The causal role of lack of social support in PPD is strongly suggested by several studies, including 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.........read more on Postpartum Depression 

Editor in Chief

Peter Charalambos