Moderately severe depressive illness can occur during the puerperium. The peak incidence appears to be at 3 months but with significant numbers of cases still appearing by 6 months and after.
A systematic review calculated the incidence and prevalence of depression in the postnatal period (i.e. antenatal and postnatal))(1)
- pooled prevalence was 11.9% of women during the perinatal period (95% CI 11.4-12.5)
- pooled prevalence for postnatal depression of 9.5% (95% CI 8.9 to 10.1) in high-income settings and 18.7% (95% CI 17.8 to 19.7) in low- and middle-income settings
The usual features are similar to non-psychotic depression appearing in women at any other time of life.
- postnatal depression is depression that occurs after a woman has given birth
- an important and common disorder that can have short- and long-term adverse impacts on the mother, her child, and the family as a whole
- associated with (2):
- impaired maternal-infant attachment,
- internalising and externalising problems in children of mothers who have postnatal depression
- especially where the depression is severe and persistent and there are familial co-morbidities
- characteristic features include:
- persistent low mood and loss of pleasure or interests,
- associated symptoms such as
- changes in appetite and energy levels
- sleep disturbance
- low self-confidence
Possible risk factors include:
- previous psychiatric history (3)
- evidence suggests that of women who experience postnatal depression (4)
- around a third also had depression in pregnancy
- and a third had pre-pregnancy depression
- poor marital relationship
- lack of social support
- stressful life events
- severe postnatal blues
It is important to distinguish postnatal depression from less severe, short-lived conditions, such as the "baby blues" (2)
- "baby blues" occurs in approximately 50% of women and resolve spontaneously within a few days
Reference:
- Woody CA et al. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders
2017;219:86-92. - Howard LM et al. Non-psychotic mental disorders in the perinatal period. Lancet 2014;384(9956):1775-88.
- Stein A et al. Effects of perinatal mental disorders on the foetus and child. Lancet 2014;384(9956):1800-19
- Wisner KL et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013;70(5):490-8.