Postnatal depression (PND) may affect men or women after the birth of a baby. Its incidence is roughly 10-15% in mothers, and up to 25% in men, though often unrecognized in the latter. It affects both maternal and infant health in physical and emotional ways. It may lead to the development of postpartum psychosis, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD).
PND has serious implications for public, maternal, and infant health. The consequences to the development of the child may be lifelong. Costs to the public health system are considerable.
The condition has a detrimental effect on the marital and family relationships as well, and may result in the breakdown of friendships, escalating the depression. Suicide is a serious result of this condition, though fortunately rare.
The prevalence of male and female postnatal depression has been reported variously by different researchers. It is needful to use validated screening tools and clinical interviews to arrive at a right diagnosis of this condition, which may account for the wide range of values with respect to prevalence and incidence of PND.
The ideal screening tool is still being developed, and should be readily available, inexpensive, short to complete, capable of being adjusted for different patient populations, and should record change in mental status over time.
Risk factors for the disorder include race, socioeconomic status, age, prenatal depression, a history of other mental disorders, alcohol or substance abuse, marital stress, poor family or social support, and the occurrence of other major life events.
The relative variance in contribution by each of these factors has been the subject of many studies, which have confirmed their important role in precipitating PND.
In addition, the part played by biological factors such as hormonal changes, and environmental conditions including lack of caregiving skills, is still to be clarified.
This is a common condition and one which is very amenable to treatment. However, several researchers have concluded that routine screening for PND is lacking in many well-baby centers.
The type of healthcare professional who conducts the interviews during such visits also plays a major role in whether mental health issues are enquired for, and if so, whether the data is recorded.
Nurse practitioners, for instance, have a much higher rate of documenting such formal screening than do physicians.
Care and Follow up
Studies are also focusing on whether depressed mothers receive the optimal type of care following a diagnosis of PND.
Many researchers have found that many mothers are advised to take medications such as antidepressants by their OB/GYN practitioners, or counseled by them.
Fewer were referred for psychological follow-up and psychotherapy was not routinely available or utilized by many depressed mothers even after diagnosis.
National guidelines on the treatment of this population of patients need to be evolved on the basis of research.
Effects of PND on the Family
The nature of the mother-infant interaction significantly suffers in PND. This affects both the participants negatively.
The cognitive, emotional, intellectual, and behavioral development of the child is delayed or impaired when the mother has severe PND, unless other compensatory factors are in play.
Moreover, when the child does not respond to the mother enthusiastically, this may further worsen her depression as she feels rejected. The importance and duration of these effects is being brought out by studies on these mothers.
Finally, research is bringing out the existence of paternal PND, the key factor being the presence of female PND, and post-adoptive PND.
The risk factors underlying PND in biological and adoptive parents are different, and are treated with specific support.
Reviewed by Afsaneh Khetrapal, BSc (Hons)