Recognizing and Screening for Postpartum Depression in Mothers of NICU Infants

Adv Neonatal Care. 2003;3(1) 

In This Article

The Spectrum of Postpartum Mood Disorders

The 3 most well-known postpartum mood disorders are as follows:

  • Maternity blues

  • PPD

  • Postpartum psychosis

Recent studies link additional mood and anxiety disorders to childbirth.[9,10,11,12] These disorders include the following:

  • Postpartum panic disorder[9]

  • Postpartum obsessive compulsive disorder[10]

  • Posttraumatic stress disorder (PTSD)[11,12]

Each of these 6 postpartum psychiatric illnesses is composed of its own unique blend of symptoms, as well as its own damaging potential for mothers and their infants.

Maternity blues is a transitory phenomenon, experienced by 50% to 80% of new mothers, that occurs within the first few days after delivery. It lasts only a short time, sometimes only for a few hours or a few days. Common symptoms include tearfulness, mood swings, and fatigue. Symptoms that persist beyond 2 weeks are more serious and inconsistent with simple maternity blues (Fig 1).

It is common to experience maternity blues that may last for a few hours or days after birth. Postpartum depression should be considered when symptoms of depression last longer than 2 weeks.

PPD is a mood disorder that occurs in 13% of new mothers.[13] It is similar to a major depressive episode as defined by the Diagnostic and Statistical Manual of Mental Disorders.[14] PPD is diagnosed when a patient reports 2 weeks of dysphoric mood or lack of interest or pleasure in usual activities, in addition to at least 4 of the following 9 symptoms: sleep disturbance, guilt, fatigue, impaired concentration, appetite disturbance, psychomotor activation or retardation, low self-esteem, feelings of hopelessness and worthlessness, and suicidal ideation.[14] A formal diagnosis is made by a trained mental health clinician based on the results of a diagnostic interview such as the Structured Clinical Interview for DSM-IV Axis I Disorders.

Postpartum psychosis is a rare, extremely serious mental illness that occurs in 1 to 2 per 1,000 deliveries. It usually presents in the first 2 to 3 weeks after delivery and requires urgent treatment. Clinical characteristics can include delusions; hallucinations; agitation; inability to sleep; and bizarre, irrational behavior.[15] Pre-existing bipolar disorder increases the vulnerability of women to episodes of postpartum psychosis.[16]

Postpartum panic disorder is a syndrome characterized by recurrent, unexpected episodes of at least 4 symptoms. These symptoms have an abrupt onset and peak within 10 minutes. Symptoms can include shortness of breath, heart palpitations, tremulousness, light-headedness, paresthesias, hot flushes or chills, nausea, diaphoresis, chest tightness, choking sensation, and cognitive symptoms of derealization and depersonalization, losing control or going crazy, impending doom, or fear of dying.[14] In postpartum obsessive-compulsive disorder, women experience repetitive, intrusive thoughts of harming their infants, fear of being left alone with their babies, and hypervigilant protectiveness of their infants.[10]

PTSD after childbirth is an underrecognized phenomenon that may occur in 3% to 5.6%[11,12] of women secondary to birth trauma. The exposure to a traumatic birth-related event leads to characteristic symptoms such as persistent re-experiencing of the event, avoidance of reminders of the stressor, numbing of responsiveness, and symptoms of increased arousal.[14] Examples of reported stressors precipitating PTSD after childbirth have ranged from a perception of inadequate care during labor and delivery to emergency cesarean deliveries.


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