March 15, 2013
Depression Affecting Surprising Number Of Women Following Childbirth
April Flowers for redOrbit.com - Your Universe Online
A surprisingly high number of women suffer from symptoms of postpartum depression, a new large-scale study from a Northwestern Medicine researcher reveals. The study is the largest scale depression screening of postpartum women done to date. It is also the first time a full psychiatric assessment has been done in a study of postpartum women who screened positive for depression.
The study, published in a recent issue of JAMA Psychiatry, included a depression screening of 10,000 women who had recently delivered babies at a single obstetrical hospital. The findings revealed a large percentage of women who suffered recurrent episodes of major depression.
Underscoring the importance of prenatal and postpartum screenings, the study highlighted the fact that both mothers' and infants' health and lives could hang in the balance. Several women who were suicidal when the researchers called on them for the screening were saved, likely due to the study's screening and immediate intervention.
“In the U.S., the vast majority of postpartum women with depression are not identified or treated even though they are at higher risk for psychiatric disorders,” said Katherine L. Wisner, M.D. “It´s a huge public health problem. A woman´s mental health has a profound effect on fetal development as well as her child´s physical and emotional development.”
Wisner, who performed the research when she was at the University of Pittsburgh, is director of Northwestern´s Asher Center for the Study and Treatment of Depressive Disorders and the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences. She is also a professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital.
“A lot of women do not understand what is happening to them,” Wisner said. “They think they´re just stressed or they believe it is how having a baby is supposed to feel.”
Out of the 10,000 surveyed in the study, 14 percent screened positive for depression. During in-home visits, 826 of the 14 percent (1,400) were given full psychiatric assessments.
-- 19.3 percent of the women who screen positive for depression considered harming themselves.
“Most of these women would not have been screened and therefore would not have been identified as seriously at risk,” Wisner said. “We believe screening will save lives.”
Approximately 20 percent of postpartum deaths are from suicide, which is the second leading cause of mortality in postpartum women.
-- Many with major postpartum depression had already experienced at least one depressive episode previously, and additionally, had an anxiety disorder.
The study revealed that 30 percent of women had depression onset prior to pregnancy, 40 percent postpartum, and another 30 percent during pregnancy. Over two-thirds also suffered from an anxiety disorder.
“Clinicians need to know that the most common clinical presentation in the post-birth period is more complex than a single episode of depression,” Wisner said. “The depression is recurrent and superimposed on an anxiety disorder.“
-- 22 percent of those who screen positive for major depression had bipolar disorder. The majority of those were undiagnosed by their doctors.
Correct diagnosis of bipolar disorder is often delayed because it depends on identifying not only the depressed phase, but the manic or hypomanic as well. Postpartum, however, is the highest risk period for episodes of mania in a woman's life.
“That´s a very high rate of bipolar disorder that has never been reported in a population screened for postpartum depression before,” said Wisner. “It is significant because antidepressant drug treatment alone can worsen the course of bipolar disorder.”
Previous research showed that women are less likely to seek treatment for depression if they have been pregnant in the last year compared to women who have not been pregnant.
Wisner noted that it is critically important to maximize a woman's overall mental and physical health during pregnancy and postpartum.
“Depression during pregnancy increases the risk to a woman and her fetus,” Wisner said. “Depression is a physiological dysregulation disorder of the entire body.”
Preterm birth and low infant birth weight have been linked to maternal prenatal stress and depression, increasing the risk of cardiovascular disease. A woman's appetite, nutrition and prenatal care is affected by depression, which is also associated with increased alcohol and drug use. Additional risks associated with depression include a higher body mass index (BMI) preconception.
A new mother's emotional state can interfere with child development if she is depressed, as well as increase the rate of insecure attachment and poor cognitive performance of her child.
The results are in line with British studies, says Dr. Ian Jones, a perinatal psychiatrist at Cardiff University. The Telegraph reports that the British studies showed the incidence of post-natal depression is between 10 and 15 percent, depending on how it was assessed and defined.
Dr. Jones called the findings of undiagnosed bipolar disorder "particularly interesting because it´s the first study to show what we have suspected for a long time.” Out of every 100 people, one to three are bipolar. Dr. Jones says that there is a sliding scale of symptoms beyond that, however.
He said, “It´s important to make the distinction between those who have bi-polar disorder and those who don´t, because the treatments are different.” Antidepressant medications can worsen bipolar disorder, he warned.
Some states, for example Illinois, require mandatory screening for perinatal mental health disorders, and Wisner says such screening, both prenatal and postpartum is essential. She cautions, however, that the mental health field must develop cost effective and accessible treatment, Wisner emphasized.
“If we identify patients we must have treatment to offer them,” Wisner said in a statement.