General Obstetrics and Gynecology: Obstetrics
The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care

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Objective

Inconsistent diagnostic criteria fail to delineate guidelines for postpartum depression surveillance. This study evaluates the validity of commonly accepted postpartum onset criteria.

Study design

Consecutive referrals to the Emory Women's Mental Health Program for evaluation of postpartum depression fulfilling criteria for major depression and taking no psychotropic medication were included. Diagnostic interview, demographics, depression scales, and the time of illness onset were obtained. Descriptive analysis was conducted for 3 participant groups: pregnancy onset, early postpartum onset within 6 weeks of delivery, and late postpartum onset.

Results

Among participants, 11.5% reported prenatal onset, 22.0% late postpartum onset, and 66.5% early postpartum symptom onset. Those reporting pregnancy onset were more likely to be unmarried, and those with a late postpartum onset were less likely to report a past history of postpartum depression.

Conclusion

The perinatal vulnerability to depression begins before delivery and extends beyond 6 weeks postpartum. Depression surveillance is therefore warranted during prenatal visits, at the postnatal check up, and at pediatric visits during the initial 6 months of the first postnatal year.

Section snippets

Subjects

Three hundred fifteen consecutive referrals to the Emory Women's Mental Health Program for evaluation of PPD were screened for study inclusion. Women were included if they presented during the first postpartum year, fulfilled DSM-IV criteria for major depression, had received no psychotropic medication during the current episode, and were able to describe a clear point of the onset of illness.

Procedures

At initial presentation, participants completed the Edinburgh Postnatal Depression Scale,12 Beck

Results

Of 315 women screened for participation, 209 fulfilled inclusion criteria. Prospective participants were excluded for taking psychotropic medication (n = 49), primary diagnosis other than major depressive disorder (n = 29), or inability to recall with specificity the time of the onset of this episode of illness (n = 28). The Figure illustrates that of the 209 women included in the study, 24 (11.5%) reported pregnancy onset (mean onset 21.8 ± 12.7 weeks' gestation), 46 (22.0%) reported late postpartum

Comment

All of the participants in this study fulfilled diagnostic criteria for major depression during the first postpartum year; however, one-third did not experience the onset of illness within the first 6 postpartum weeks. The results of the current study are consistent with previous reports of perinatal depression beginning during pregnancy or later than 6 weeks post partum.6, 7, 8, 9, 10, 11

Similarly, the higher rate of single mothers in the pregnancy onset group is consistent with previous data

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  • Cited by (0)

    Supported in part by an unrestricted grant from Pfizer, Inc., and a National Institutes of Health K23 Patient-Oriented Research Career Development Award (D.J.N.).

    Dr Stowe is a member of the GlaxoSmithKline Advisory Board.

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