Psychiatry and primary careAntenatal risk factors for postpartum depression: a synthesis of recent literature
Introduction
Depression is common in women of childbearing age [1] and debate has long ensued over whether the postpartum period is a time of increased risk for mood disorders [2], [3]. Although the overall prevalence of depression does not appear to be higher in women after delivery as compared to age-matched comparison women [3], [4], [5], [6], serious depression requiring admission to hospital is clearly more prevalent [2], [7]. The occurrence of depressive illness following childbirth can be detrimental to the mother, her marital relationship, and her children, and can have adverse long-term effects if untreated. For her children, a mother's ongoing depression can contribute to later emotional, behavioral, cognitive, and interpersonal problems. Because of these serious consequences, early diagnosis and treatment interventions of postpartum illnesses are imperative for the health and well-being of the mother and child. The literature on postpartum depression is somewhat problematic, with conflicting opinions about its uniqueness as a disorder, its etiology, and its risk factors. We undertook a systematic, evidence-based literature review for risk factors for postpartum depression to help guide public health policy and best practices, the results of which are presented and discussed.
Section snippets
Postpartum affective disorders
Postpartum affective disorders are typically divided into three categories: postpartum blues, postpartum depression, and puerperal (postpartum) psychosis. The prevalence, onset, and duration of the three types of postpartum affective disorders are shown in Table 1 (adapted from [8]).
Methods
Because the literature on postpartum depression is vast and extremely variable in quality, the following criteria were used in this systematic evidence-based review, in order to identify articles of good scientific quality.
The research studies were of human subjects, empirical, peer-reviewed, and published in English between 1990 and 2002 (excluding seminal studies prior to these dates). Studies had to state both the diagnostic and temporal criteria of postpartum depression used, only cases of
Depression or anxiety during pregnancy
The results of the studies consistently found that experiencing depressed mood or anxiety during pregnancy were significant predictors of postpartum depression [18], [28], [30], [31], [32]. Moreover, higher levels of anxiety during pregnancy predicted the level of postpartum depressive symptomatology [18], [24], [28], [31], [32], [33].
Past history of psychiatric illness
Similarly, there is little question that a past history of psychiatric illness puts women at risk for depression in the postpartum period. The average effect size
Discussion
All women are susceptible to developing depression following childbirth, however, women who have certain risk factors have a significantly increased risk of experiencing the illness.
Based on current research, the strongest predictors of postpartum depression are women who experience depression or anxiety during pregnancy or have a previous history of depressive illness. Women who have recently experienced a stressful life event, and those who perceive they have low levels of social support,
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