depression in pregnant and postpartum women

by Christine B. Sieberg, Ed.M., M.A.

Motherhood can and should be a time of great joy. For many, though, the period following birth can be a time of great despair and anguish – those suffering from a condition called postpartum depression.

Hippocrates, the ancient physician and "father of medicine" – and the namesake of the "Hippocratic oath" traditionally taken by doctors – identified a link between mental illness and the “postpartum” period more than 2000 years ago. More recently both significant media attention andsubstantial research identify the first year after birth as the lifetime peak of psychiatric admissionsamong women.

Yet postpartum depression is not specified as a separate disorder by the International Classification of Diseases nor the Diagnostic and Statistical Manual of Mental Disorders. In fact, very few studies address the postpartum period, while research onroutine medical exams has found that postpartum mood disorders often go undetected for both thewoman and her infant.

Women need to be advocates for themselves and their unborn babies and children. Prenatal depression has been associated withlow birth weight. Prenatal and postnatal depression– or maternal stress – has been found to negatively impact a developing child, or perhaps more alarming, that it can be transmitted to the infant in utero. Other studies have shown that preschool children who have been exposed to pervasive and chronic stress, such as parental depression, have behavioral issues that may develop into controlling ways of interacting with others.

The good news is diagnostic criteria have been developed to assess postpartum depression. There is also research on prenatal depression, and we knowthat it impacts about 8-16% of new mothers duringthe first year after childbirth.

Yet we also know that one third or fewer ofwomen with it are ever diagnosed. There is limited research on effective prevention and early intervention strategies, while other studies show that when it is identified, typically fewer than 30% of womenwho need help actually ever seek the treatment. Symptoms can be recognized. Women suffering from postpartum depression tend to have more severe symptoms than women who have depression separate from the postpartum period.

Symptoms last at least two weeks and consist of: decreased mood and concentration; sleep and appetite disturbance; fatigue; irritability; guilt; loss of pleasure; indecisiveness; and feelings of worthlessness and despair. Severe symptoms include: paranoia, hallucinations, and thoughts of harming oneself or the baby. Some women may be more susceptible; all women need to address it.

Certain groups seem to suffer from postpartum depression at higher rates. A recent study published in Obstetrics and Gynecology found that in 655 women who were 2 to 6 weeks postpartum, 47% of Hispanic and 45% of Black mothers reported depressive symptoms compared to 31% of Whitemothers. Other research shows that, irrespective ofrace, teen mothers, unmarried women, poorer women and women with decreased social supportsare also impacted more.

Discussion of these findings is not to scare women who may be at-risk for or currently experiencing these symptoms. Rather it is the hope that this article will help to empower women to seek help if necessary. Better assessment and screening is needed to ensure that women at-risk are identified and preventive interventions can be implemented. But until then, pregnant and postpartum women who are experiencing symptoms of anxiety and depression are encouraged to speak to their healthcare professionals.

Christine B. Sieberg, Ed.M.; M.A., is a doctoral candidate in clinical psychology at the URI. She graduated summa cum laude from Boston College with a degree in elementary/moderate special needs education and human development. She also holds a Master of Arts in Applied Developmental and Educational Psychology from Boston College and a Master of Education with a specialization in Risk and Prevention in Children from Harvard University. Sieberg’s clinical and research interests are in health prevention and intervention services specifically in the areas of childhood trauma, anxiety, and pediatric and maternal health.

photo courtesy of Sieberg