Postpartum Psychiatric Disorders Research Articles

Non-psychotic psychiatric disorders after childbirth: Prevalence and comorbidity in a community sample

Background Postnatal psychiatric morbidity is a frequent and serious complication of childbirth. The aim of the present study was to determine the prevalence and co-occurrence of DSM-IV psychiatric disorders in a community sample of postpartum Spanish mothers. Methods A two-phase cross-sectional study was conducted in which all consecutive women attending the routine 6-week postnatal control visit at the Department of Obstetric and Gynecology of a university-affiliated hospital over a one year period were included. In the first phase, 1453 women were screened with the Edinburgh Postnatal Depression Scale (EPDS). In the second phase, 428 participants stratified according to employment status and EPDS outcomes were randomly selected within each stratum for clinical psychiatric evaluation using the Structured Clinical Interview for DSM-IV. Weighted prevalence estimates were obtained for DSM-IV disorders with or without comorbidity. Results The overall 6-week prevalence rate for postpartum psychiatric disorders was 18.1% (95% CI 15.0–21.8) and 2.0% (95% CI 1.2–2.9) of postpartum women met criteria for more than one disorder. Mood disorders was the most prevalent group (9.8%; 95% CI 7.9–12.1) followed by adjustment disorders (4.3%; 95% CI 3.0–6.3), and anxiety disorders (4%; 95% CI 3.0–6.3). Comorbidity was associated to major depressive disorder. Limitations Underestimation of some disorders due to the cross-sectional design and the use of a screening instrument with good psychometric characteristics restricted to depression, anxiety, and adjustment disorders. Conclusions In the context of a 6-week postnatal visit, a high prevalence and heterogeneity of postnatal psychiatric morbidity in a community sample of Spanish women was found.

Androgenic steroids as unexpected predictors of postpartum psychiatric disturbances

Postpartum psychiatric disorders develop in a significant number of otherwise healthy women. Because of the enormous decline in estradiol and progesterone after delivery, a relationship has been inferred between those changes and the onset of psychiatric symptoms. Little research has been done to characterize a broader range of hormone concentrations over the peripartal time frame and their potential causal relationship with emergent psychiatric disorders. This study investigated associations between nine psychiatric symptom clusters using the Symptom Checklist 90-R against changes in salivary progesterone, dehydroepiandrosterone sulfate (DHEAS), testosterone, estrone, estradiol and estriol concentrations in a cohort of 28 healthy, primigravid women. Concentrations of estradiol and progesterone declined as expected, but were not associated with postpartum psychiatric symptoms. Supra-physiological concentrations of DHEAS and diminished antenatal testosterone were significantly and consistently correlated with anxiety related symptoms and mild psychotic disturbances. These findings are consistent with the pharmacologic properties of these androgenic steroids and suggest that perinatal assessment of DHEAS and testosterone may be useful for prediction of and proactive intervention for postpartum psychiatric disturbances.

Physical and psychosocial disturbances of the partners of women with severe postpartum psychiatric disorders

Physical and psychosocial disturbances of the partners of women with severe postpartum psychiatric disorders

Prevalence of postnatal psychiatric morbidity: a preliminary analysis

Objective:There is no empirical research on the occurrence of postnatal psychiatric morbidity in Spanish population. To determine the prevalence rate of DSM-IV psychiatric disorders in postpartum Spanish mothers.Method:A two-phase cross-sectional epidemiological study. Women consecutively attending in the routine postnatal check-up (at six weeks after delivery) in the Department of Obstetric and Gynaecology of the Clinic Hospital during one year were included. In the first phase, 1453 women were screened with the EPDS. In the second phase, based upon EPDS outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation with the Structured Clinical Interview (SCID) for DSM-IV to determine psychiatric status. Weighted prevalence and its 95% Confidence Intervals (95%CI) were obtained for DSM-IV diagnostic groups.Results:The overall 6-weeks prevalence rate for postpartum psychiatric disorders was 18.1% (95% CI 15.0-21.8). The most prevalent DSM-IV diagnostic group was mood disorders (9.8%; 95% CI 7.9-12.1), follow-up by adjustment disorders group (4.3%; 95% CI 3.0-6.3), anxiety diagnostic group (3.9%; 95% CI 2.5-5.8) and “other” disorders group (1.1%; 95% CI: 0.3-3.8%).Conclusions:This results shows the heterogeneity of postnatal psychiatric morbidity. We found that DSM-IV diagnosis of mood disorders in postpartum women were more prevalent than anxiety disorders, in contrast with recent studies in postnatal community women. Clinical and research evaluation of mental health in postpartum women should include a full range of mental disorders.This study has been supported in part by grant 13/00 from Ministery of Work and Social Affairs, Institute of Women, Spain.

Risk factors for postpartum depression: A preliminary study

Background:Postpartum psychiatric disorders constitute an important field of problems due to the fact that they lead to an increase in mortality both in infant and mother. A history of mental disorders and stressful life events during pregnancy and post partum period, poor familial and social relations are stated as important risk factors. The aim of this study is to specify the risk factors associated with PPD in Turkish women.Methods:Among 185 women that gave birth in a state hospital, 80 were suitable and admitted to the study. One month after the birth, subjects were interviewed with an assessment battery including SCID-I, Edinburgh Postnatal Depression Scale and a semistructured interview form concerning the sociodemographic and risk factors for PPD.Results:Thirty percent of our subjects were diagnosed as PPD. Patients with PPD had more severe depressive symptoms during the last 3 months of pregnancy, higher rates of history of depression, PPD, postpartum blues, premenstrual dysphoric disorder, parental depression, poor social support, stressful life events during last 1 year, and problems in marriage as compared those without PPD. There was no significant difference between groups with respect to type of birth and pregnancy, history of abortion and curettage, and emotional response to oral contraceptive drugs.Conclusions:Assessing the factors that increase the liability to PPD would make it easier to detect the individuals with high risk and to provide earlier professional support to those individuals.

Depression after Delivery: Risk Factors, Diagnostic and Therapeutic Considerations

Postpartum mood disorders can negatively affect women, their offspring, and their families when left untreated. The identification and treatment of postpartum depression remains problematic since health care providers may often not differentiate postpartum blues from depression onset. Recent studies found potentially new risk factors, etiologies, and treatments; thus, possibly improving the untreated postpartum depression rates. This integrated review examined several postpartum psychiatric disorders, postpartum blues, generalized anxiety, obsessive compulsive disorder, post-traumatic stress disorder, and postpartum psychosis for current findings on prevalence, etiologies, risk factors, and postpartum depression treatments.

Maternal bond and mother–child interaction in severe postpartum psychiatric disorders: Is there a link?

Mothers in the puerperium are vulnerable to a wide spectrum of postpartum psychiatric disorders. One of the central psychological processes of the puerperium is the development of an emotional relationship with the baby. The bond to the infant as well as the interaction with the baby are two aspects of the mother-infant relationship that can be disturbed by mothers with postpartum psychiatric disorders. Dysfunctional maternal cognitions may also influence the development of an emotional bonding and the establishment of a positive interaction with the child. The aim of this study is to investigate differences in the self-perceived experience of bonding and the observed mother-child interaction of severely ill postpartum depressive and psychotic mothers. In addition the association between subjective experience of bonding and objective measurement of mother-child interaction will be described. Results show that depressive mothers perceived their bonding to the baby more negatively than psychotic mothers. No differences could be found in the objective interactional behaviour of the mothers in both groups, with the exception that the infants of psychotic mothers showed more eye contact avoidance towards their mothers. The subjective experience of motherhood clearly influences the maternal interactional behaviour with depressive mothers as well as with psychotic mothers.

Depression and anxiety during pregnancy and six months postpartum: a follow‐up study

To investigate the relationship between antenatal and postpartum depression and anxiety and to explore associated maternal characteristics. From a population-based sample of 1,555 women attending two obstetric clinics in Sweden, all women with an antenatal psychiatric diagnosis (n = 220) and a random selection of healthy women (n = 500) were contacted for a second assessment three to six months postpartum. The Primary Care Evaluation of Mental Disorders was used for evaluation on both occasions. Fewer cases of depressive and/or anxiety disorders were prevalent postpartum compared with the second trimester screening. Depression and/or anxiety were prevalent in 16.5% of postpartal women versus 29.2% of pregnant women. There was a significant shift from a majority of subthreshold diagnoses during pregnancy to full Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnoses during the postpartum period. A history of previous psychiatric disorder, living single, and obesity were significantly associated with a new-onset postpartum psychiatric disorder. The absence of a previous psychiatric disorder was significantly associated with a postpartum recovery of depression or anxiety. Depression and anxiety appear to be less common postpartum than during pregnancy.

Postpartum Psychiatric Disorders: What Do We Know And Where Do We Go?

Biological, psychological as well as sociocultural changes occur during the postpartum period and it is a highrisk time for significant psychiatric illness. Postpartum psychiatric disorders had been described for centuries yet these disorders today are still poorly recognized and under-treated. They are currently categorized into postpartum blues, postpartum depression and postpartum psychosis. Panic disorder, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder and Posttraumatic Stress Disorder typify the anxiety disorders of this period. This mini-review describes what is known about postpartum psychiatric disorders in terms of their clinical presentation, etiology and treatment. Lactation issues, the impact on the child, cultural considerations as well as life cycle challenges are also discussed. Significant findings are critically reviewed and potential future research directions that could lead to substantial advancements are identified. Keywords: Postpartum disorders, mood and anxiety disorders, lactation, child outcome, culture, female lifecycle stage

The Role of Estrogen Therapy in Postpartum Psychiatric Disorders: An Update

The aim of this review is to assess and summarize the existing literature data about the efficacy of estrogen replacement therapy (ERT) in preventing and treating postpartum psychiatric disorders. An extensive and unrestrictive computerized search (from 1970 to June 2005) on MEDLINE/PubMed, TOXNET, EMBASE, and Cochrane Databases was conducted with the following search terms: estradiol, estrogen-treatment, hormonal treatment, therapy, postpartum depression, postnatal depression, puerperal depression, postpartum blues, postpartum psychosis, lactation, and breastfeeding. In assessing available literature information about the role of ERT in preventing and treating puerperal psychiatric diseases, all reviewed studies were found to suffer from severe methodological limitations. Well-designed and strictly focused multicenter trials are warranted in order to firmly establish the effectiveness of ERT in puerperal psychiatric disorders.

Inpatient treatment of women with postpartum psychiatric disorders – the role of the male partners

Postpartum psychiatric disorders are stressful events for all members of the family. The male partners contribute to the women's coping process. To evaluate the men's supportive function we investigated 31 partners of 34 women with postpartum psychiatric disorders. Three male partners were unreachable although we tried to contact them intensively. All the women examined were in-patients of a mother-child unit after delivery. The men's behaviour in the relationship, in their role as a partner, and as a father were rated in a categorical-qualitative way. We found that nearly one third of the male partners can be described as "supportive". This finding strongly correlates with the subjective experience of the corresponding wives of being supported by the male partners. However in the subgroup of women who had already suffered from prepartum psychiatric disorders with onset before index-delivery, the majority of the male partners were rated and experienced as "non-supportive". Additionally, ten of these men suffered from several DSM-IV/ICD-10 based psychiatric disorders themselves. Using the standardised questionnaire "operationalisierte psychodynamische Diagnostik" (OPD) we describe the higher ego-strength of the supportive male partners. We found that there was a reduction in the length of stay in the hospital in the families with supportive male partners.

Prognosis of postpartum psychiatric disorders in a Turkish sample

ObjectiveThe postpartum period represents a time of increased risk for psychiatric disorders. Postpartum depression is especially very common. Many aetiological risk factors have been reported for postpartum psychiatric disorders. The purpose of this study was to evaluate the postpartum psychiatric disorders in a Turkish sample and discuss their course.MethodsThe files of 6000 inpatients who were admitted to Gazi University School of Medicine Psychiatry Department were evaluated retrospectively, and 67 patients were chosen whose psychiatric illness had began puerperally. These patients were grouped according to age of onset of the illness, number of episodes and the type of these episodes, their postpartum psychiatric diagnoses and illness prognosis.ResultsOf 6000 patients, 67 (1.11%) were diagnosed as having a postpartum psychiatric disorder: 56.7% (n=38) were diagnosed as having a postpartum psychotic disorder, while 35.8% (n=24) as having an affective disorder. Forty-seven patients (70.1%) received a diagnosis of major psychiatric disorder during their follow-up.ConclusionThese results show that postpartum diagnoses may show a chronic course and cause a life-time psychiatric illness and therefore patients should be monitored carefully for psychotic symptoms even after the acute period is over.

Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality.

The Confidential Enquiry into Maternal Deaths 1997 to 1999 finds that psychiatric disorder, and suicide in particular, is the leading cause of maternal death. Suicide accounted for 28% of maternal deaths. Women also died from other complications of psychiatric disorder and a significant minority from substance misuse. Some of the findings of the Confidential Enquiry confirm long established knowledge about postpartum psychiatric disorder. The findings highlight the severity and early onset of serious postpartum mental illness and of the risk of recurrence following childbirth faced by women with a previous history of serious mental illness either following childbirth or at other times. These findings led to the recommendation that all women should be asked early in their pregnancy about a previous history of serious psychiatric disorder and that management plans should be in place with regard to the high risk of recurrence following delivery. Other findings of the Enquiry were new and challenged some of the accepted wisdoms of obstetrics and psychiatry. It is likely that the suicide rate following delivery is not significantly different to other times in women's lives and for the first 42 days following delivery may be elevated. This calls into question the so-called 'protective effect of maternity'. The overwhelming majority of the suicides died violently, contrasting with the usual finding that women are more likely to die from an overdose of medication. Compared to other causes of maternal death, the suicides were older and socially advantaged. The Enquiry findings suggest that the risk profile for women at risk of suicide following delivery may be different to that in women at other times and in men. None of the women who died had been admitted at any time to a Mother and Baby Unit and their psychiatric care had been undertaken by General Adult Services. None of the women who died had had a previous episode correctly identified and none had had adequate plans for their proactive care. The conclusion is that there is a need for both Psychiatry and Obstetrics to acknowledge the substantial risk that women with a previous psychiatric history of serious mental illness face following delivery.

Psychoneuroendocrinology: The Scientific Basis of Clinical Practice

Psychoneuroendocrinology: The Scientific Basis of Clinical Practice

Abnormal, abusive, and stress-related behaviors in baboon mothers

Background Psychiatric disturbances during pregnancy and the postpartum period are especially serious, given the negative effects on the mother as well as the child. Understanding the causes of such disturbances has been difficult owing to the complexity of psychological, social, experiential, biological, and genetic factors involved. Methods To determine the potential utility of a nonhuman primate model for the study of postpartum disorders, the pathologic and stress-related behavior of 62 female baboons living in social groups was studied during pregnancy and after the birth of an infant. Results The prevalence of abnormal behavior and self-directed scratching (a measure of stress response) was higher after birth of the infant. Subjects displayed a significantly higher frequency per hour of these behaviors postpartum, which increased over 8 weeks. Abusive behaviors toward the infant were common, occurring in 55% of the subjects. Mothers with low dominance rank, who usually have lower levels of social support, had higher levels of abusive behavior during the postpartum period. Conclusions Baboons show variation in measurable behaviors related to stress and abnormal functioning during the pre- and postpartum periods, indicating that a nonhuman primate model may be useful in the study of factors affecting postpartum psychiatric disorders and infant abuse.

Identification and classification of postpartum psychiatric disorders.

1. Postpartum depression has been used as a catchall phase for many postpartum emotional symptoms. Categorizing a number of diverse disorders under one title has resulted in an inability to identify who is most at risk for developing postpartum problems. 2. The postpartum period is a particularly vulnerable period for depression, despite the fact that it is perceived as a time of joy and emotional well-being. 3. By increasing awareness among all health care professionals who care for women during the period following childbirth, postpartum psychiatric disorders can be identified early and treated correctly. 4. Limiting postpartum psychiatric disorders to postpartum depression may result in limited or inappropriate treatment options.

The course of postpartum psychiatric disorders in women and their partners.

This study examined the course of postpartum psychiatric disorders in a community sample of mothers and their partners to determine whether sociodemographic variables, life stress, and psychiatric history were related to persistence of mental health problems. At 6 months postpartum, 48 index couples where the wife had a psychiatric disorder at 2 months postpartum and 50 control couples with no such diagnosis underwent diagnostic interviews and completed questionnaires on psychological symptoms, life stress, and treatment history. The results indicate that at follow-up, 54% of the index mothers still had a psychiatric diagnosis, as did 60% of their partners who had had a psychiatric diagnosis at 2 months postpartum. Socioeconomic status, country of origin, and life stress were related to persistence, as were diagnosis and timing of onset of the disorder. About a third of the parents were referred for treatment. It is concluded that for many families, postpartum psychiatric disorders are not a transient phenomenon.

Association between oestradiol and puerperal psychosis

Objective: Postpartum psychiatric disorders with long-lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy. Method: Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale. Results: In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms. Conclusion: The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.

Association between oestradiol and puerperal psychosis

Postpartum psychiatric disorders with long-lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy. Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale. In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms. The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.

Long-Term Course and Outcome of Severe Postpartum Psychiatric Disorders

Thirty-nine women who had suffered from a severe first-episode postpartum psychiatric illness were re-examined after a period of 6–26 years (averaging 12.5 years). Diagnoses were established according to ICD-10 and Leonhard’s classification, revealing a marked predominance of cycloid psychoses (54%) according to Leonhard. There was no evidence of the nosological independence of postpartum psychosis. Only 4 patients (10%) had never recovered fully since the onset of the illness. In contrast, 6 patients had undergone a monophasic course without any further psychopathology. In 20 cases (51%) the illness had run a multiphasic course. The average number of episodes per patient was 2.5 (range 2–6). The course was not determinable in 4 patients (10%). Nineteen women (49%) had 22 further deliveries after the first manifestation of the illness. The frequency of a relapse in connection with further pregnancy or delivery was 50%. Applying the Strauss-Carpenter Outcome Scale, we found a favourable outcome for the total sample with a mean value of 14.1 (SD = 2.6). The vast majority of patients (75%) showed no persistent alterations. Our findings provide further evidence of a favourable prognosis of severe postpartum psychiatric disorder despite the remarkably high rate of puerperal relapses.