PPD

Postpartum Depression, also called postnatal depression (PPD), is a form of clinical depression which can affect women, and less frequently men, after childbirth. Studies report prevalence rates among women from 5% to 25%, but methodological differences among the studies make the actual prevalence rate unclear. Among men, in particular new fathers, the incidence of postpartum depression has been estimated to be between 1.2% and 25.5%. Postpartum depression occurs in women after they have carried a child, usually in the first few months, and may last up to several months or even a year. Symptoms include sadness, fatigue, changes in sleeping and eating patterns, reduced libido, crying episodes, anxiety, and irritability. Although a number of risk factors have been identified, the causes of PPD are not well understood. Many women recover with a treatment consisting of a support group or counseling. The Edinburgh Postnatal Depression Scale, a standardized self-reported questionnaire, may be used to identify women who have postpartum depression.[5] PPD and the “baby blues”.

Baby or maternity blues are a mild and transitory moodiness suffered by up to 80% of postnatal women (and in some cases fathers). Symptoms typically last from a few hours to several days, and include tearfulness, irritability, hypochondriasis, sleeplessness, impairment of concentration, feelings of isolation and headache. The maternity blues are not the same thing as postpartum depression, nor are they a precursor to postpartum depression or postnatal psychosis.

Symptoms

Symptoms of PPD can occur anytime in the first year postpartum and include, but are not limited to, the following:

  • Sadness
  • Hopelessness
  • Low self-esteem
  • Guilt
  • A feeling of being overwhelmed
  • Sleep and eating disturbance
  • Inability to be comforted
  • Exhaustion
  • Emptiness
  • Anhedonia
  • Social withdrawal
  • Low or no energy
  • Becoming easily frustrated
  • Feeling inadequate in taking care of the baby
  • Impaired speech and writing
  • Spells of anger towards others
  • Increased anxiety or panic attacks
  • Decreased sex drive

One method of detecting Postnatal Depression (PND) is the use of Edinburgh Postnatal Depression Scale. If the new mother scores more than 13, she is likely to develop PND.

Risk factors

While the causes of PPD are not understood, a number of factors have been identified as predictors of PPD (the effect size is given in parentheses, where larger values indicate larger effects):

  • Formula feeding rather than breast-feeding (2.04)
  • A history of depression (1.87) (.38 to.39) Beck (2001)
  • Cigarette smoking (1.58)
  • Low self esteem (.45 to. 47) Beck (2001)
  • Childcare stress (.45 to .46) Beck (2001)
  • Prenatal depression during pregnancy (.44 to .46) Beck (2001)
  • Prenatal anxiety (.41 to .45) Beck (2001)
  • Life stress (.38 to .40) Beck (2001)
  • Low social support (.36 to .41) Beck (2001)
  • Poor marital relationship (.38 to .39) Beck (2001)
  • Infant temperament problems/colic (.33 to .34) Beck (2001)
  • Maternity blues (.25 to .31) Beck (2001)
  • Single parent (.21 to .35) Beck (2001)
  • Low socioeconomic status (.19 to .22) Beck (2001)
  • Unplanned/unwanted pregnancy (.14 to .17) Beck (2001)

Of these, three factors – formula feeding, a history of depression, and cigarette smoking – have been shown to be additive effects.

These factors are known to correlate with PPD. “Correlation” in this case means that, for example, high levels of prenatal depression are associated with high levels of postnatal depression, and low levels of prenatal depression are associated with low levels of postnatal depression. But this does not mean the prenatal depression causes postnatal depression—they might both be caused by some third factor. In contrast, some factors, such as lack of social support, almost certainly cause postpartum depression. (The causal role of lack of social support in PPD is strongly suggested by several studies, including O’Hara 1985, Field et al. 1985; and Gotlib et al. 1991.) Anthropologists Kruckman and Stern tested the idea cross culturally, and their pioneering study determined six ways in which postpartum rituals, including the use of the postpartum ritual, la cuarentena, in Chicago Latina mothers, to protect or cushion the expression of mood disorders.

 

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