Postpartum depression: what pediatricians need to know.

Abstract

1. Linda H. Chaudron, MD, MS* 1. *Assistant Professor, Psychiatry, Pediatrics, and Obstetrics and Gynecology; Director, Women’s Mental Healthcare, Strong Memorial Hospital, University of Rochester School of Medicine, Rochester, NY After completing this article, readers should be able to: 1. Describe the range of symptoms and severity of postpartum depression (PPD). 2. Delineate the appropriate, validated screening tools for detecting PPD. 3. List the percentage of women in whom PPD is detected within the current standard of practice. 4. Describe the effects of PPD on maternal-infant interactions and parental attitudes and behaviors. 5. Characterize the method of determining optimal treatment of PPD. Postpartum depression (PPD) is a significant public health problem, each year affecting 10% to 20% of new mothers. Many of these women and their children experience short- and long-term adverse consequences. Despite an increasing awareness of the effects of maternal depression on children’s health and welfare, it remains unrecognized and poorly understood by women and clinicians alike. Because pediatricians encounter mothers repeatedly during the postpartum year, it is important that they recognize PPD and appropriately educate and refer mothers for evaluation and treatment. PPD describes a heterogeneous group of depressive symptoms and syndromes that occurs during the first year following birth. The American Psychiatric Association Diagnostic and Statistical Manual of Mental Health Disorders -IV (DSM IV) uses the term “postpartum” more specifically to describe symptoms of major depressive disorder, bipolar disorder, or brief psychotic disorder beginning within 4 weeks of delivery. The psychiatric postpartum experiences usually are divided into three categories: “maternal blues,” PPD, and postpartum psychosis. The DSM IV does not apply “postpartum” to other psychiatric illnesses. However, anxiety disorders, such as panic, obsessive-compulsive disorder, and phobias, can have an initial onset or exacerbation in the postpartum period. Maternal blues or postpartum mood reactivity is considered a “normal” emotional experience for women in the immediate postpartum period. It is estimated that 50% to 80% of new mothers experience transient symptoms of depressed mood, at times alternating with elated moods, irritability, increased crying …