More pregnant women depressed than previously estimated

Suicides among new mothers could be prevented if depression is detected and treated

New motherA new, large-scale study by a Northwestern Medicine research team and published in JAMA Psychiatry has found that a surprisingly high number of women have postpartum depressive symptoms. This is the largest scale depression screening of postpartum women and the first time a full psychiatric assessment has been done.

The study, which included a depression screening of 10,000 women who had recently delivered infants at single obstetrical hospital, revealed that a high number of women suffered repeated episodes of major depression.

The study highlights how important prenatal as well as postpartum screening is. “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 Northwestern Medicine lead study author Katherine L. Wisner, M.D. “It’s a huge public health problem. A woman’s mental health has a profound effect on foetal development as well as her child’s physical and emotional development.”
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.”

In the study, 14 per cent of the women screened positive for depression. Of that group, 826 received full psychiatric assessments during at-home visits. The assessments revealed the following:

  • In women who screened positive for depression, 19.3 per cent had self-destructive thoughts“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.”About 20 per cent of postpartum deaths [second most common cause] are as a result of suicide.
  • During the research, many women who were detected with major depression postpartum had already experienced at least one episode of depression previously and were also suffering from anxiety disorder. The study found 30 per cent of women had depression onset prior to pregnancy, 40 per cent postpartum and 30 percent during pregnancy. More than two-thirds of these women also had 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 per cent of women detected with major depression also had bipolar disorder, most of whom had not been diagnosed by their physicians. There is often a delay in correctly diagnosing bipolar disorder, which depends on identifying not only the depressed phase but the manic or hypomanic phase as well. But postpartum is the highest risk period for new 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.”

Maximising a woman’s overall mental and physical health in pregnancy and after childbirth is critically important.

“Depression during pregnancy increases the risk to a woman and her foetus,” Wisner said. “Depression is a physiological regulation disorder of the entire body.”

When a new mother is depressed, her emotional state can interfere with child development and increase the rate of insecure attachment and poor cognitive performance of her child.

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