The study included a depression screening of 10,000 women and a full psychiatric assessment of the women who screened positive for depression.
“In the U.S., the vast majority of postpartum women with depression are not identified or treated, even though they are at higher risk for psychiatric disorders,” said Dr. Katherine Wisner, director of Northwestern’s Asher Center for the Study and Treatment of Depressive Disorders.
“It’s a huge public health problem. A woman’s mental health has a profound effect on fetal development, as well as her child’s physical and emotional development.”
A lot of women do not understand what is happening to them, according to Wisner.
“They think they’re just stressed or they believe it is how having a baby is supposed to feel,” she said.
In the study, 14 percent of the women screened positive for depression. Of that group, 826 received full psychiatric assessments during at-home visits.
Researchers found that 19.3 percent of the women who screened positive for depression thought of harming themselves. In fact, Wisner noted that the lives of several women who were suicidal when staff members called them were likely saved as a result of the study’s screening and immediate intervention.
“Most of these women would not have been screened and therefore would not have been identified as seriously at risk,” Wisner said. “We believe screening will save lives.”
Suicide accounts for about 20 percent of postpartum deaths and is the second most common cause of death in postpartum women, she noted.
The study also found that 30 percent of women who screened positive for postpartum depression were depressed before their pregnancy, while 30 percent reported being depressed while pregnant. More than two-thirds of the women also had an anxiety disorder.
“Clinicians need to know that the most common clinical presentation in the post-birth period is more complex than a single episode of depression,” Wisner said. “The depression is recurrent and superimposed on an anxiety disorder.“
Of the women who screened positive for major depression, 22 percent had bipolar disorder, the majority of whom had not been diagnosed by their physicians, she continued.
There is often a delay in correctly diagnosing bipolar disorder, which depends on identifying not only the depressed phase but the manic or hypomanic phase as well, Wisner explained. Postpartum is the highest risk period for new episodes of mania in a woman’s life, she added.
“That’s a very high rate of bipolar disorder that has never been reported in a population screened for postpartum depression before,” said Wisner. “It is significant because antidepressant drug treatment alone can worsen the course of bipolar disorder.”
Depression during pregnancy increases the risk to a woman and her fetus, according to Wisner.
“Depression is a physiological dysregulation disorder of the entire body,” she said.
Maternal prenatal stress and depression is linked to preterm birth and low infant birth weight, which increases the risk of cardiovascular disease, she said. Depression also affects a woman’s appetite, nutrition and prenatal care and is associated with increased alcohol and drug use.
Additionally, when a new mother is depressed, her emotional state can interfere with child development and increases the rate of insecure attachment and poor cognitive performance of her child, Wisner said.
While screening for depression is essential, it is also essential that cost-effective and accessible treatment is available, the researcher said.
“If we identify patients, we must have treatment to offer them,” Wisner said.
The study is published in JAMA Psychiatry.
Source: Northwestern University