CLINICAL ISSUES
Identifying and Treating Postpartum Depression

https://doi.org/10.1177/0884217505274583Get rights and content

Postpartum depression affects 10% to 20% of women in the United States and negatively influences maternal, infant, and family health. Assessment of risk factors and depression symptoms is needed to identify women at risk for postpartum depression for early referral and treatment. Individual and group psychotherapy have demonstrated efficacy as treatments, and some complementary/alternative therapies show promise. Treatment considerations include severity of depression, whether a mother is breastfeeding, and mother’s preference. Nurses who work with childbearing women can advise depressed mothers regarding treatment options, make appropriate recommendations, provide timely and accessible referrals, and encourage engagement in treatment.

Section snippets

Description, Prevalence, and Course

Symptoms that typically characterize PPD include despair, sadness, anxiety, fears, compulsive thoughts, feelings of inadequacy, loss of libido, fatigue, and dependency (Sichel, 2000). A diagnosis of PPD requires a major depressive episode with onset during the first 4 weeks after delivery (American Psychiatric Association, 2000); however, researchers commonly define depression occurring within 3 months postpartum as PPD (Wisner, Parry, & Piontek, 2002). According to psychiatric diagnostic

Identifying Women at Risk for Postpartum Depression

Identifying women who may be at increased risk for PPD is an important clinical goal. Despite growing knowledge that PPD is a major childbirth complication, postpartum depression screening is not yet standard care in the United States (Georgiopoulis et al., 1999; Horowitz et al., 2001).

Medical Considerations

If PPD is suspected, a clinical evaluation includes screening for thyroid disease, anemia, and diabetes because these disorders can influence or mimic mood disorder symptoms (Sichel, 2000). Assessment of hormonal contraception is relevant. The widely held view that oral contraceptives contribute to mood disorders is not supported uniformly. Results from randomized placebo-controlled trials provide only limited evidence that oral contraception may induce symptoms of depression and anxiety (

Treatment Options for PPD

PPD is a treatable disorder. Prompt intervention improves long-term outcomes (Brennan et al., 2000, Brockington, 2004). Nurses who work with childbearing women need current knowledge about available evidence-based treatments to facilitate women’s informed decisionmaking about treatment options and to make appropriate referrals. Treatment options include individual and group psychotherapies, psychopharmacologic therapy, and complementary/alternative therapies. Approaches frequently are combined

Conclusions and Clinical Implications

PPD is a serious disorder that affects a large cross section of women. Factors such as prenatal and past maternal depression history, current life and parenting stress, poor quality of relationships and social support, and very young age and very low socioeconomic status may increase PPD risk. A sizable group of women who experience PPD are at risk for chronic depression. In addition, PPD negatively affects the health of infants, children, mothers, and fathers and the overall quality of the

REFERENCES (85)

  • H.P. Kennedy et al.

    A light in the fog: Caring for women with postpartum depression

    Journal of Midwifery and Women’s Health

    (2002)
  • M.C. Logsdon et al.

    Role functioning and symptom remission in women with postpartum depression after antidepressant treatment

    Archives of Psychiatric Nursing

    (2003)
  • K.S. Peindl et al.

    Identifying depression in the first postpartum year: Guidelines for office-based screening and referral

    Journal of Affective Disorders

    (2004)
  • D.N. Ugarriza

    Group therapy and its barriers for women suffering from postpartum depression

    Archives of Psychiatric Nursing

    (2004)
  • M. Wroblewski et al.

    Implementing a comprehensive postpartum depression support program

    AWHONN Lifelines

    (2004)
  • S. Abraham et al.

    Oral contraception and cyclic changes in premenstrual and menstrual experience

    Journal of Psychosomatic Obstetrics and Gynecology

    (2003)
  • L.L. Altshuler et al.

    The expert consensus guideline series: Treatment of depression in women

    (2001)
  • L.C. Amankwaa

    Postpartum depression among African-American women

    Issues in Mental Health Nursing

    (2003)
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (5th ed., text...
  • American Psychiatric Association

    American Psychiatric Association practice guidelines for the treatment of psychiatric disorders: Compendium 2002

    (2002)
  • L. Appleby et al.

    A controlled study of fluoxetine and cognitive-behavioural counseling in the treatment of postnatal depression

    British Medical Journal

    (1997)
  • M.P. Austin et al.

    Antenatal screening for postnatal depression: A systematic review

    Acta Psychiatrica Scandinavica

    (2003)
  • A.T. Beck et al.

    BDI-II manual

    (1996)
  • C.T. Beck

    The effects of postpartum depression on maternal-infant interaction: A meta-analysis

    Nursing Research

    (1995)
  • C.T. Beck

    Postpartum depressed mothers’ experiences interacting with their children

    Nursing Research

    (1996)
  • C.T. Beck

    Maternal depression and child behaviour problems: A meta-analysis

    Journal of Advanced Nursing

    (1999)
  • C.T. Beck

    Predictors of postpartum depression: An update

    Nursing Research

    (2001)
  • C.T. Beck et al.

    Postpartum Depression Screening Scale

    (2001)
  • K. Berggren-Clive

    Out of the darkness and into the light: Women’s experiences with depression after childbirth

    Canadian Journal of Community Mental Health

    (1998)
  • P.A. Brennan et al.

    Chronicity, severity, and timing of maternal depressive symptomatology during the first postpartum year

    Developmental Psychology

    (2000)
  • S. Brown et al.

    Physical health problems after childbirth and maternal depression at six to seven months postpartum

    BJOG: An International Journal of Obstetrics and Gynaecology

    (2000)
  • V.K. Burt et al.

    The use of psychotropic medications during breast-feeding

    American Journal of Psychiatry

    (2001)
  • S.B. Campbell et al.

    The timing and chronicity of postpartum depression: Implications for infant development

  • H. Chabrol et al.

    Prevention and treatment of post-partum depression: A controlled randomized study on women at risk

    Psychological Medicine

    (2002)
  • R. Clark et al.

    Psychotherapy for postpartum depression: A preliminary report

    American Journal of Orthopsychiatry

    (2003)
  • L.S. Cohen et al.

    Venlafaxine in the treatment of postpartum depression

    Journal of Clinical Psychiatry

    (2001)
  • P. Cooper et al.

    The development and validation of a predictive index for postpartum depression

    Psychological Medicine

    (1996)
  • P.J. Cooper et al.

    Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression

    British Journal of Psychiatry

    (2003)
  • M. Corral et al.

    Bright light therapy’s effect on postpartum depression

    American Journal of Psychiatry

    (2000)
  • J.L. Cox et al.

    Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale

    British Journal of Psychiatry

    (1987)
  • G. Dawson et al.

    On the origins of a vulnerability to depression: The influence of the early social environment on the development of psychobiological systems related to risk for affective disorder

  • N. Epperson et al.

    Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs

    American Journal of Psychiatry

    (2001)

    • Cited by (77)

    • Relation between mothers’ types of labor, birth interventions, birth experiences and postpartum depression: A multicentre follow-up study

      2018, Sexual and Reproductive Healthcare

    • Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects

      2018, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
      Citation Excerpt :

      In this current project, we showed the feasibility of establishing a universal screening protocol among a cohort of postpartum parents of high-risk neonates. Obstetric nurses are well positioned to provide guidance about postpartum psychological distress, to detect the presence of symptoms, and to initiate mental health referral (Horowitz & Goodman, 2005). The maternity unit provides a unique opportunity to ensure that women and their partners receive a mental health assessment in the early postpartum period (Segre et al., 2014) and are screened by staff before discharge if psychological risks are endorsed.

    • Principles of Supportive Psychotherapy for Perinatal Distress

      2017, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
      Citation Excerpt :

      Nurses and other maternity care providers should focus on accessing and delivering appropriate resources that are available to support a woman whether or not symptoms are present. Researchers found evidence that early detection of depression symptoms augments recovery, which supports the key role nurses play in assessing and counseling women about the symptoms of perinatal anxiety and depression (Horowitz & Goodman, 2005). Moreover, researchers identified the importance of recognizing women at risk in obstetric, pediatric, and family practice settings (Alhusen & Alvarez, 2016).

    • Antenatal depressive symptoms and subjective birth experience in association with postpartum depressive symptoms and acute stress reaction in mothers and fathers: A longitudinal path analysis

      2017, European Journal of Obstetrics and Gynecology and Reproductive Biology

    • Kangaroo care and postpartum depression: The role of oxytocin

      2017, International Journal of Nursing Sciences
      Citation Excerpt :

      In addition, even though only small amounts of antidepressant medications are secreted in breastmilk, there is insufficient research to show whether this is safe for newborns [31]. Therefore, most mothers are reluctant to take pharmacological treatments and see non-pharmacological treatments as more acceptable [30]. The non-pharmacological interventions for PPD include listening visits (a form of intervention started in Britain that focuses on the mother's experience with her child, particularly if the mother is facing problems in taking care of her newborn [6]); cognitive behavioral therapy (CBT) that focuses on helping depressed mothers modify their negative thoughts by changing their behaviors to improve their ability to cope and reduce stress [32]; interpersonal therapy, psychoeducation, psycho-supportive therapy [30], and KC [33].

    • Examining the Screening Practices of Physicians for Postpartum Depression: Implications for Improving Health Outcomes

      2015, Women's Health Issues
    View all citing articles on Scopus
    View full text
    Copyright © 2005 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.