The Lowdown on Postpartum Depression
Ten to 15 out of every 100 mothers report feelings of depression during the first year after giving birth. The US Centers for Disease Control and Prevention (CDC) has recently analyzed data taken from PRAMS (the Pregnancy Risk Assessment Monitoring System) during 2004 and 2005 to assess the prevalence and demographic characteristics associated with postpartum depression (PPD) as reported by the mothers themselves.
Data came from 17 states and ranged from the lowest prevalence in Maine (11.7%) to the highest, in New Mexico (20.4%). The level of depression was based upon the way the women responded to two questions, the answers of which were paired with demographic statistical data.
The 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 chose a response from a list that offered “always,” “often,” “sometimes,” “rarely,” and “never” as options. When “always” and “often” were chosen, the mother was classified as self-reporting PPD.
Maternal demographic data included mother’s age at delivery, highest level of education, race or ethnicity, marital status, and whether or not financial aid from the Medicaid program was used to pay for delivery expenses.
Risk factors weighed included the need for NICU (neonatal intensive care unit) admission, low birth weight, how many earlier live births, use of tobacco during last trimester of pregnancy, physical abuse before or during the pregnancy, and stressful events that occurred during the pregnancy and in the year before it. Tobacco use was defined as one or more cigarettes a day during the final three months of pregnancy. Physical abuse meted out by a current or former husband or partner was defined as a push, slap, hit, kick, choking, or other physical pain caused in any way. Stressors were defined as emotional, financial, relationship/partner, or traumatic.
Upon assessment of the data, it was found that the youngest mothers, those with the least education, and those who received Medicaid financial assistance were the most likely to report feelings of PPD. Non-Hispanic white mothers were the least likely to answer affirmatively to PPD symptoms.
Five risk factors described above were considered significant in the majority of cases when the data was formulated on a state-by-state basis:
Tobacco use
Physical abuse
Relationship/partner stress
Traumatic stress that occurred during the pregnancy
Financial stress during pregnancy
Giving birth to a baby at low birth weight and emotional stress during the pregnancy proved to be significant factors for the risk of PPD in 14 states. Nine states identified NICU admission as increasing the risk of PPD.
It is important to understand that PPD is not merely “baby blues” and often requires medical treatment. Baby blues are reported more frequently than PPD but usually happens within the first few weeks of delivery whereas PPD may strike at any time during the first year after delivery. Symptoms of baby blues are much less severe than PPD and don’t often require medical treatment whereas PPD does.
PPD is of concern for both the mother’s and the baby’s long-term health. Mothers with PPD are usually less enthusiastic about motherhood and may engage in behaviors that don’t fully promote optimum child development, such as playing with it and breastfeeding.
The analysis of this data suggests the need to target effective services for mothers who are at high risk of PPD, including PPD screening during follow-up examinations 4 to 6 weeks after delivery as recommended by the American College of Obstetricians and Gynecologists.
Source: Morbidity and Mortality Weekly Report