postpartum depressive illness

Last edited 03/2021 and last reviewed 03/2021

Moderately severe depressive illness can occur during the puerperium. The peak incidence appears to be at 3 months but with significant numbers of cases still appearing by 6 months and after.

A systematic review calculated the incidence and prevalence of depression in the postnatal period (i.e. antenatal and postnatal))(1)

• pooled prevalence was 11.9% of women during the perinatal period (95% CI 11.4-12.5)
• pooled prevalence for postnatal depression of 9.5% (95% CI 8.9 to 10.1) in high-income settings and 18.7% (95% CI 17.8 to 19.7) in low- and middle-income settings

The usual features are similar to non-psychotic depression appearing in women at any other time of life.

• postnatal depression is depression that occurs after a woman has given birth
• an important and common disorder that can have short- and long-term adverse impacts on the mother, her child, and the family as a whole
• associated with (2):
  • impaired maternal-infant attachment,
  • internalising and externalising problems in children of mothers who have postnatal depression
    • especially where the depression is severe and persistent and there are familial co-morbidities
• characteristic features include:
  • persistent low mood and loss of pleasure or interests,
  • associated symptoms such as
    • changes in appetite and energy levels
    • sleep disturbance
    • low self-confidence

Possible risk factors include:

• previous psychiatric history
  • evidence suggests that of women who experience postnatal depression (4)
    • around a third also had depression in pregnancy
  • and a third had pre-pregnancy depression
• poor marital relationship
• lack of social support
• stressful life events
• severe postnatal blues

It is important to distinguish postnatal depression from less severe, short-lived conditions, such as the "baby blues" (2)

• "baby blues" occurs in approximately 50% of women and resolve spontaneously within a few days

Reference:

1. Woody CA et al. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders
   2017;219:86-92.
2. Howard LM et al. Non-psychotic mental disorders in the perinatal period. Lancet 2014;384(9956):1775-88.
3. Stein A et al. Effects of perinatal mental disorders on the fetus and child. Lancet 2014;384(9956):1800-19
4. Wisner KL et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013;70(5):490-8.