Elsevier

General Hospital Psychiatry

Volume 26, Issue 4, July–August 2004, Pages 289-295
General Hospital Psychiatry

Psychiatry and primary care
Antenatal risk factors for postpartum depression: a synthesis of recent literature

https://doi.org/10.1016/j.genhosppsych.2004.02.006Get rights and content

Abstract

Postpartum nonpsychotic depression is the most common complication of childbearing, affecting approximately 10–15% of women and, as such, represents a considerable health problem affecting women and their families. This systematic review provides a synthesis of the recent literature pertaining to antenatal risk factors associated with developing this condition. Databases relating to the medical, psychological, and social science literature were searched using specific inclusion criteria and search terms, in order to identify studies examining antenatal risk factors for postpartum depression. Studies were identified and critically appraised in order to synthesize the current findings. The search resulted in the identification of two major meta-analyses conducted on over 14,000 subjects, as well as newer subsequent large-scale clinical studies. The results of these studies were then summarized in terms of effect sizes as defined by Cohen. The findings from the meta-analyses of over 14,000 subjects, and subsequent studies of nearly 10,000 additional subjects found that the following factors were the strongest predictors of postpartum depression: depression during pregnancy, anxiety during pregnancy, experiencing stressful life events during pregnancy or the early puerperium, low levels of social support, and a previous history of depression. Critical appraisal of the literature revealed a number of methodological and knowledge gaps that need to be addressed in future research. These include examining specific risk factors in women of lower socioeconomic status, risk factors pertaining to teenage mothers, and the use of appropriate instruments assessing postpartum depression for use within different cultural groups.

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,

References (53)

  • A Josefsson et al.

    Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms

    Obstet Gynecol

    (2002)
  • T.H Holmes et al.

    The Social Readjustment Rating Scale

    J Psychosom Res

    (1967)
  • V Patel et al.

    Women, poverty and common mental disorders in four restructuring societies

    Soc Sci Med

    (1999)
  • R.C Kessler et al.

    The epidemiology of major depressive disorder. Results from the National Comorbidity Survey Replication (NCS-R)

    JAMA

    (2003)
  • R.E Kendell et al.

    Epidemiology of puerperal psychoses

    Br J Psychiatry

    (1987)
  • M.W O'Hara et al.

    Controlled prospective study of postpartum mood disorderscomparison of childbearing and nonchildbearing women

    J Abnorm Psychol

    (1990)
  • J.L Cox et al.

    A controlled study of the onset, duration and prevalence of postnatal depression

    Br J Psychiatry

    (1993)
  • R Kumar et al.

    A prospective study of emotional disorders in childbearing women

    Br J Psychiatry

    (1984)
  • M.W O'Hara et al.

    Controlled prospective study of postpartum mood disorderspsychological, environmental, and hormonal variables

    J Abnorm Psychol

    (1991)
  • Paffenbarger RS. Epidemiological aspects of mental illness associated with childbearing. In: Brockington IF, Kumar R,...
  • R Nonacs et al.

    Postpartum mood disordersdiagnosis and treatment guidelines

    J Clin Psychiatry

    (1998)
  • M.W O'Hara et al.

    Prospective study of postpartum depressionprevalence, course, and predictive factors

    J Abnorm Psychol

    (1984)
  • H Kennerly et al.

    Maternity blues. I. Detection and measurement by questionnaire

    Br J Psychiatry

    (1989)
  • B Pitt

    Maternity blues

    Br J Psychiatry

    (1973)
  • I.F Brockington et al.

    Puerperal psychosis. Phenomena and diagnosis

    Arch Gen Psychiatry

    (1981)
  • C Dean et al.

    The symptomatology of puerperal illness

    Br J Psychiatry

    (1981)
  • J.L Klompenhouwer et al.

    Classification of postpartum psychosisa study of 250 mother and baby admissions in The Netherlands

    Acta Psychiatr Scand

    (1991)
  • S.A Robling et al.

    Long-term outcome of severe puerperal psychiatric illnessa 23 year follow-up study

    Psychol Med

    (2000)
  • J Schopf et al.

    On the nosology of severe psychiatric post-partum disorders. Results of a catamnestic investigation

    Eur Arch Psychiatry Neurol Sci

    (1984)
  • T Reich et al.

    Postpartum psychoses in patients with manic depressive disease

    J Nerv Ment Dis

    (1970)
  • M.W O'Hara et al.

    Rates and risk of postpartum depression—a meta-analysis

    Int Rev Psychiatry

    (1996)
  • B.R Troutman et al.

    Nonpsychotic postpartum depression among adolescent mothers

    J Abnorm Psychol

    (1990)
  • G.E Robinson et al.

    Postpartum disorders

  • Diagnostic and statistical manual of mental disorders

    (1994)
  • R.A Remick

    Diagnosis and management of depression in primary carea clinical update and review

    CMAJ

    (2002)
  • Hostetter AL, Stowe ZN. Postpartum mood disorders. Identification and treatment. In: Lewis-Hall F, Williams TS, Panetta...
  • Cited by (1445)

    • The impact of fetal surgical procedures on perinatal anxiety and depression

      2024, American Journal of Obstetrics and Gynecology MFM
    View all citing articles on Scopus
    View full text