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Postpartum depressive illness

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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
    • 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:

  1. 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.
  2. Howard LM et al. Non-psychotic mental disorders in the perinatal period. Lancet 2014;384(9956):1775-88.
  3. Stein A et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014;384(9956):1800-19
  4. 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.

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