Postpartum Depression Affects 1 in 9 New Mothers

Diana Swift

February 20, 2017

Approximately one in nine women in the United States experience depressive symptoms after giving birth, according to a surveillance analysis published in the February 17, 2017 issue of Morbidity and Mortality Weekly Report. However, the proportion of mothers who experience postpartum depression has recently declined in some states.

The overall prevalence of self-reported postpartum depressive symptoms (PDS) was 11.5% in 2012 for the 27 states included in the current analysis. Individual states showed wide variation, however, ranging from a low of 8.0% in Georgia to a high of 20.1% in Arkansas, according to data from the CDC Pregnancy Risk Assessment Monitoring System.

PDS prevalence was highest among new mothers 24 years of age or younger and those of American Indian, Alaskan Native, Asian, or Pacific Islander ethnicity. Other risk factors associated with PDS included having 12 or fewer years of education, unmarried status, being a postpartum smoker, and experiencing three or more stressful life events in the year before delivery. Giving birth to a full-term but low-birth-weight infant, and having a newborn admitted to neonatal intensive care were also associated with PDS.

The self-reported prevalence of PDS dropped from 14.8% in 2004 to 9.8% in 2012 (P < .01) in the 13 states for which there were data from all three reporting periods included in the analysis (2004, 2008, and 2012).

Between 2004 and 2012, significant declines were noted in eight of the 13 states, including Alaska, Colorado, Georgia, Hawaii, Minnesota, Nebraska, Utah, and Washington, write Jean Y. Ko, PhD, of the division of reproductive health, National Center for Chronic Disease Prevention and Health Promotion, and colleagues. No significant changes were apparent in Maine, Maryland, Oregon, Rhode Island, and Vermont.

The 2012 survey sample was comprised of more than 1.6 million women representing 41% of US births. Self-reported PDS was ascertained by responses to two questions: "Since your new baby was born, how often have you felt down, depressed, or hopeless?" and "Since your new baby was born, how often have you had little interest or little pleasure in doing things?" Women responding "always" or "often" to either question were classi­fied as experiencing PDS.

Earlier this year, a large population-based study reported that gestational diabetes and pre-pregnancy depression were also risk factors for PDS. And another recent study found that postnatal depression also strikes new fathers.

As for the reasons for the decline, Dr Ko and colleagues point to the substantial drop in the birth rate among teenagers 15 to 19 years old from 41.5 per 1000 females in 2007 to 24.2 per 1000 females in 2014. Also, the preterm birth rate dropped from 10.4% in 2007 to 9.5% in 2014, and the proportion of women self-reporting stressful life events in the year before delivery fell by 0.54% per year from 2000 to 2010.

In terms of therapy, the authors noted an increase in antidepressant prescriptions for pregnant women from 0.7% during 2002–2006 to 2.1% during 2007–2010, which may have contributed to the PDS decline.

The authors call for increased recognition of risk factors and improved screening and treatment before and during pregnancy. Although the increased use of antidepressants might have contributed to the decline, Dr Ko and associates write, "[M]ore efforts are needed to reduce PDS prevalence in certain states and subpopulations of women."

Such efforts are needed as postpartum depression is associated with lower rates of breastfeeding initiation and shorter duration of breastfeeding, impaired mother–infant bonding, and devel­opmental disorders in infants.

Postpartum depression is treatable with pharmacologic therapy and behavioral interventions, the authors stress. "These findings underscore the value of universal screening and appropriate treatment," they write. They also urge further study of the etiology of postpartum depression.

MMWR. 2017;66(6):153-158. Full text

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