Etiology and Pathophysiology of Postpartum Depression

Postpartum depression is characterized by many different symptoms such as depressed mood and lack of interest in normal, daily activities, disturbances in sleep and appetite, lack of energy, and suicidal thoughts or actions. This can be challenging for healthcare professionals because changes in appetite and sleep which lead to lack of energy are extremely common because of the nature of having a new member of the family to take care of. 

The risk of depression is increased within the first year of childbirth, with adolescents being more susceptible to postpartum depression than other women. People who have experienced depression before are more likely to experience postpartum depression. Social factors play a major role in the likelihood of a person experiencing postpartum depression. Women who have low levels of education, little social support such as the lack of a partner, women experiencing poverty and women who abuse drugs or alcohol are more likely to experience postpartum depression than other women. Another factor is the pregnancy and delivery itself. Unplanned pregnancy, problems during pregnancy and delivery, and the mode of delivery have been argued as factors that can contribute to postpartum depression.

Postpartum depression not only affects the mother and her well-being, but affects the wellbeing of the child. Infancy is a crucial time for development, and if the mother does not have the capacity to bond with her baby, the child will experience developmental delays. Furthermore, postpartum depression increases instances of infanticide and infant neglect.

One conflict medical professionals face when evaluating the etiology and pathophysiology of depression in new mothers is the tension between the positive and adverse effects of psychotropic medication. While giving a mother psychotropic medication decreases the risk of suicide, infanticide, substance abuse, and malnutrition, there may be adverse side effects for a fetus or child that is exposed to these drugs. However, there are also adverse side effects for the child if their mother's bonding with the child is disrupted during this crucial developmental stage.  

http://www.sciencedirect.com/science/article/pii/S0896627308005886

http://www.medscape.com/viewarticle/775406

http://dareallalucedoula.com/postpartum-support-for-new-moms/more-than-just-the-baby-blues-all-about-pnd-postnatal-depression/

Who Is Affected?

If you haven’t experienced postpartum depression or been aware of anyone close to you going through it, it may surprise you how common it actually is. The statistics vary from source to source and country to country, of course. The prevalence in Singapore is estimated to be nearly 0%, as opposed to almost 57% in Brazil. In the U.S., the estimated average prevalence rate comes out to about 15%, which means for every 4 million annual live births there are 600,000 new mothers who suffer from postpartum depression. Note that this takes into account only live births, and does not account for episodes of depression involving miscarriages or stillbirths. 

Obviously there is more to determining the likelihood of experiencing postpartum depression than just math. There are several risk factors for postpartum depression, including:

A history of depression or bipolar disorder.

Having a family member with a history of mental illness. 

Medical complications during childbirth.

Substance abuse.

Lack of emotional support from parter, family, or friends.

While postpartum depression can affect any mother, regardless of age, race, ethnicity, or socioeconomic status, there are certain demographic factors which seem to make it more likely for a woman to experience postpartum depression. Many studies have stated that the prevalence rate is higher in high-poverty areas, reaching as high as 25%. 

There has also been research suggesting that immigrant women in the U.S. are more susceptible to postpartum depression than are native born women. Researchers at Brigham Young University conducted interviews with ninety-six Hispanic women who had given birth within the past year. The women all completed the Postpartum Depression Screening Scale (PDSS) tool in Spanish, which asked questions about areas such as anxiety/insecurity, sleeping and eating disturbances, and guilt/shame. The results showed a prevalence of 54%, significantly higher than the average prevalence in the United States. This is consistent with other studies which have found a higher prevalence among Hispanic women. 

An important part of breaking down the stigma surrounding postpartum depression is realizing how many women actually are affected by it, and understanding there is a good chance that someone you know has been, is, or will be going through it too.

What is Postpartum Depression?

The period of time following labor is often portrayed as a season of joy and wonder for new mothers. After the long discomfort of pregnancy and the painful intensity of delivery, mom gets to hold her baby in her arms and hear his crying and cooing and see his face without the aid of an ultrasound machine. Everything has been building up to this and it’s considered a sort of payoff moment, with all the challenges and frustrations finally culminating in this beautiful meeting. 

This is the common picture of postpartum, but it is not reflective of many women’s experience. 

An immediate sense of bonding with your child is by no means a guarantee. Between 60% and 80% of new mothers experience “baby blues”, while about 15% of new mothers in the United States experience a more serious and long-lasting mood disorder known as postpartum depression. In defining postpartum depression, it is important to clarify what the baby blues are to emphasize that there is an important difference between the two.

The baby blues are common among the majority of new mothers. The baby blues are characterized by anxiety, irritability, mood swings, and crying, sometimes for no apparent reason. This tends to last no longer than ten days after delivery.

Postpartum depression sometimes gets confused with the postpartum blues and while there may initially be some similarities, the symptoms of postpartum depression are more severe and do not eventually go away on their own; they get worse over time and require treatment. Mothers with postpartum depression may experience feelings of guilt, worthlessness, hopelessness, sadness, and restlessness, just to name a few. Postpartum depression can present differently from individual to individual. For example, some mothers become overly anxious and worried about their new child while other mothers show little to no interest in their baby. 

Postpartum depression is a multi-faceted and complicated issue and, like most mental/mood disorders, is surrounded by stigma. It is important to encourage communication and education on postpartum depression to support the mothers, babies, and families whom it affects.