1. Postpartum Depression

2. Occurence Approximately 500,000 of the 4 million American women giving birth each year experience postpartum depression (PPD) – About 12-13% of new mothers PPD is under detected and under treated Many barriers exist to detection and treatment

3. Depression In the United States, depression is the leading cause of non-obstetric hospitalizations among women aged 18-44. In the year 2007, 14% of women aged 18-44 were diagnosed with depression. Seven percent of all hospitalizations among young women were for depression.

4. Perinatal Psychological Disorders The Blues Postpartum Depression Postpartum Psychosis

5. Postpartum Blues Most common, 50-80% Relatively brief – Few hours to several days Onset usually in first week to 10 days Post Pregnancy Typically recover spontaneously – May represent the initial stages of PPD/PPP

6. Typical Blues Symptoms Low Mood Mood Swings Insomnia Anxiety Crying Irritability

7. Postpartum Psychosis Rare: 1/1000 postpartum women Hallucinations and/or Delusions Risk Factors: History Bipolar Affective Disorder/Psychosis Family history of psychosis Having first child Aggressive intervention absolutely necessary

8. Postpartum Psychosis Usually Begins Within 90 Days Postpartum Length is Quite Variable Prevalence Ranges: 1/500 to 1/1000 Family history of bipolar disorder 33/1000 Family history of postpartum psychosis 22/1000 Personal history bipolar disorder: 1/2 Chance of Future Postpartum Psychosis

9. Postpartum Depression Not as mild or transient as the blues Not as severely disorienting as psychosis Ranges in severity Often undetected

10. Symptoms of Major Depression Depressed Mood Decreased or increased appetite with or without weight changes Insomnia or Hypersomnia Low energy/fatigue Loss of Interest or Pleasure Feelings of worthlessness or guilt Concentration or problems making decisions Suicidal thoughts

11. Postpartum Depression: Risk Factors Lower SES/unemployment Past depression or anxiety disorder Past history of alcohol abuse Stressful life-events Poor marital relationship Inadequate social support Child-care related stressors African American ethnicity

12. Effects of Perinatal Depression: An Overview Depression negatively effects: Mother’s ability to mother Mother—infant relationship Emotional and cognitive development of the child

13. Postpartum Depression: Maternal Attitudes – Infants perceived to be more bothersome – Make harsh judgments of their infants – Feelings of guilt, resentment, and uncertainty toward child – Loss of affection toward child

14. Postpartum Depression: Maternal Behaviors Gaze less at their infants Take longer to respond to infant’s utterances Show fewer positive facial expressions Lack awareness of their infants Increased risk for abusing children

15. Postpartum Depression: Maternal Interactions Mothers respond to their infants sometimes in a flat, monotone voice. They have feelings that the child is intrusive and bothersome to their life.

16. What Can Be Done? Routinely screen for Perinatal Depression Disorders If a mother screens positively for PDD or Postpartum Psychosis she is immediately referred to treament.

17. Barriers to Detection Women will present themselves as well as they are ashamed and embarrassed to admit that they are not feeling happy Media images contribute to this phenomena

19. Reality for New Mothers Tired Alone at home Lots of care for the baby Sometimes there are other young children who need care Not much time for self Complete loss of control over time

20. Screening Who? Primary health care professionals Physicians/Nurses: Obstetrics, Family Practice, Pediatrics Case Managers/Social Workers

21. Treatment Psychotherapy Medication