Predictors, prodromes and incidence of postpartum depression

The purpose of this study was to determine the incidence of clinically significant depression occurring between 7 and 4 months postpartum and to investigate whether somatic complaints, subsyndromal depressive symptoms, or birth-related concerns among non-depressed women at 1 month were predictive of postpartum depression. This is a prospective cohort study of 465 women from the Wisconsin Maternity Leave and Health Project (WMLHP). Women who were not depressed at 1 month postpartum were reassessed 3 months later for depression occurring at any time in the interval between 1 and 4 months postpartum. Depression was defined as either meeting the criteria for major depression on the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) or scoring above 15 on the Center for Epidemiologic Studies Depression Scale (CES-D). Physical symptoms were assessed by an adapted Health Responses Scale. Other measures were developed specifically for the WMLHP. Of 465 women, 27 (5.8%) became clinically depressed between 1 and 4 months postpartum. In a logistic regression analysis, four variables (maternal age, depression during pregnancy, thoughts of death and dying at 1 month postpartum, and difficulty falling asleep at 1 month postpartum) were predictive of depression at 4 months postpartum. Breast-feeding, mode of delivery, family income, parity and mother‘s education did not predict depression. The existence of subsyndromal depressive symptoms, particularly thoughts of death and dying, may represent a prodromal phase of depression and should alert clinicians to the possibility of future postpartum depression. Women with a history of depression during pregnancy should be monitored for signs of postpartum depression for a minimum of 4 months. Obstetricians are in a unique position during the postpartum check-up to screen women for these predictors of future postpartum depression and possibly to avert the development of a clinically significant depressive episode.

[1]  T. Therneau,et al.  Population-based screening for postpartum depression. , 1999, Obstetrics and gynecology.

[2]  P. Sullivan,et al.  Latent class analysis of lifetime depressive symptoms in the national comorbidity survey. , 1998, The American journal of psychiatry.

[3]  Y. Lecrubier.  Is depression under‐recognised and undertreated? , 1998, International clinical psychopharmacology.

[4]  John A. Rice,et al.  A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. , 1998, Archives of general psychiatry.

[5]  S. Stuart,et al.  Postpartum anxiety and depression: onset and comorbidity in a community sample. , 1998, The Journal of nervous and mental disease.

[6]  J. Hyde,et al.  Maternity Leave, Role Quality, Work Involvement, and Mental Health One Year After Delivery , 1998 .

[7]  M. Righetti-Veltema,et al.  Risk factors and predictive signs of postpartum depression. , 1998, Journal of affective disorders.

[8]  I. Jones,et al.  Postnatal depression in the community. , 1998, The British journal of general practice : the journal of the Royal College of General Practitioners.

[9]  K. Kendler,et al.  Boundaries of major depression: an evaluation of DSM-IV criteria. , 1998, The American journal of psychiatry.

[10]  E. Tronick,et al.  The impact of maternal psychiatric illness on infant development. , 1998, The Journal of clinical psychiatry.

[11]  V. Boyko,et al.  Prospective study of postpartum depression in an Israeli cohort: prevalence, incidence and demographic risk factors. , 1998, Journal of psychosomatic obstetrics and gynaecology.

[12]  T. Brugha,et al.  The Leicester 500 Project. Social support and the development of postnatal depressive symptoms, a prospective cohort survey , 1998, Psychological Medicine.

[13]  J. Coyne,et al.  Depression in Primary Care—More like Asthma Than Appendicitis: The Michigan Depression Project , 1997, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[14]  O. Bernazzani,et al.  Psychosocial predictors of depressive symptomatology level in postpartum women. , 1997, Journal of affective disorders.

[15]  J. Fisher,et al.  Adverse Psychological Impact of Operative Obstetric Interventions: A Prospective Longitudinal Study , 1997, The Australian and New Zealand journal of psychiatry.

[16]  K. Wells,et al.  Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. , 1996, The American journal of psychiatry.

[17]  C T Beck,et al.  A meta-analysis of predictors of postpartum depression. , 1996, Nursing research.

[18]  H. Barros,et al.  Correlates of Postnatal Depression in Mothers and Fathers , 1996, British Journal of Psychiatry.

[19]  L. Appleby,et al.  Demographic and Obstetric Risk Factors for Postnatal Psychiatric Morbidity , 1996, British Journal of Psychiatry.

[20]  W. Eaton,et al.  Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset. , 1995, The American journal of psychiatry.

[21]  P. Zelkowitz,et al.  Screening for Post-Partum Depression in a Community Sample , 1995, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[22]  F. Hassanyeh,et al.  Long-term outcome of post-partum psychiatric illness requiring admission. , 1994, Journal of affective disorders.

[23]  M. Klein,et al.  Pregnant or depressed? The effect of overlap between symptoms of depression and somatic complaints of pregnancy on rates of major depression in the second trimester , 1994 .

[24]  V. Pop,et al.  Prevalence of post partum depression: or is it post‐puerperium depression? , 1993, Acta obstetricia et gynecologica Scandinavica.

[25]  G. Simon,et al.  Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study. , 1991, The American journal of psychiatry.

[26]  G. Fava,et al.  Prodromal symptoms in affective disorders. , 1991, The American journal of psychiatry.

[27]  M. O’Hara,et al.  Prospective study of postpartum depression: 4 1/2-year follow-up of women and children. , 1991, Journal of abnormal psychology.

[28]  D. Gath,et al.  The Relationship between Post-natal Depression and Mother–Child Interaction , 1991, British Journal of Psychiatry.

[29]  David Bruce Lewis,et al.  Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables. , 1991, Journal of abnormal psychology.

[30]  E. J. Wright,et al.  Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. , 1990, Journal of abnormal psychology.

[31]  I. Gotlib,et al.  Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. , 1989, Journal of consulting and clinical psychology.

[32]  A. Day,et al.  Non-Psychotic Psychiatric Disorder After Childbirth , 1988, British Journal of Psychiatry.

[33]  V. Whiffen.  Vulnerability of postpartum depression: a prospective multivariate study. , 1988, Journal of abnormal psychology.

[34]  R. Kumar,et al.  Impact of maternal postnatal depression on cognitive development of young children. , 1986, British medical journal.

[35]  P. Gard,et al.  A Multivariate Investigation of Postpartum Mood Disturbance , 1986, British Journal of Psychiatry.

[36]  M. Brown,et al.  Social Support, Stress, and Health: A Comparison of Expectant Mothers and Fathers , 1986, Nursing research.

[37]  M. Brown,et al.  Social Support During Pregnancy: A Unidimensional Or Multidimensional Construct? , 1986, Nursing research.

[38]  M. O’Hara,et al.  Prospective study of postpartum depression: prevalence, course, and predictive factors. , 1985, Journal of abnormal psychology.

[39]  M. O’Hara,et al.  Prospective study of postpartum depression : Prevalence, course, and predictive factors , 1984 .

[40]  R. Kumar,et al.  A Prospective Study of Emotional Disorders in Childbearing Women , 1984, British Journal of Psychiatry.

[41]  L. Robins,et al.  Validity of the Diagnostic Interview Schedule, Version II: DSM-III diagnoses , 1982, Psychological Medicine.

[42]  L. Robins,et al.  National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. , 1981, Archives of general psychiatry.

[43]  M. Weissman,et al.  Use of a self-report symptom scale to detect depression in a community sample. , 1980, The American journal of psychiatry.

[44]  L. Radloff.  The CES-D Scale , 1977 .