Lois' Lodge is a member of Prevent Child Abuse- North Carolina.
The following is an excellent article that I received on the subject of maternal depression.
This is a subject relevant to all of us.
Prevention Network Monthly Focus
MATERNAL DEPRESSION
For all one hears that having a baby is "the happiest time in a mother's life," a significant percentage of mothers in fact experience some form of depression during pregnancy or following the birth of their child. Postpartum Depression can occur up to a year after birth, although its onset is usually within the first three months after delivery. Common symptoms include changes in appetite and sleep patters, decreased energy, feelings of worthlessness or guilt, and difficulty thinking or concentrating, recurrent thoughts of death or suicidal plans and attempts. As with any illness, Postpartum Depression exists along a continuum and therefore can take many forms:
∙ It can appear as a mild and relatively common condition known as "Baby Blues" in which the mother experiences increased crying, irritability, and anxiety during the first three days after the baby's birth.
∙ However, it can also be as severe as Postpartum Psychosis, a rare condition that occurs in 1 to 2 women in 1000 births, in which a mother can experience hallucinations and extremely irrational behavior.
In many cases, depressed mothers are not overtly symptomatic, but their interactions with their children include negative emotional expressions, an unresponsive parenting style, and a feeling of disconnect.
Prevalence
Estimates of the prevalence of postpartum depression range from 8-20% of women who give birth. In 2000, North Carolina was one of seven states to conduct a survey about Postpartum Depression using the Pregnancy Risk Assessment Monitoring System (PRAMS), which was developed by the Centers for Disease Control in 2000. The survey, which relied on self-reported cases of postpartum depression rather than a clinical diagnosis, found that 8.5% of North Carolina mothers reported severe depression in the months after their delivery, and 49.4% reported low to moderate depression. A study from the State Center for Health Statistics looked at what factors helped indicate whether or not a mother sought help for her depression. The study found that older mothers (30+) were more than twice more likely than teenage mothers to seek help. Other factors that correlated with seeking help were higher levels of education and having had previous births.
The Risk Factors
There are a number of risk factors that help predict postpartum depression. Although there is no significant difference between low income Caucasian and African American women, Hispanic mothers do experience a higher prevalence of depressive symptoms. Other risk factors included being young, less educated, having fewer financial resources, not having a spouse or cohabitating partner, and delivering a low birth weight infant. Research into protective factors is more limited, but they do include breastfeeding, positive feelings about the pregnancy, and living with a spouse or significant other.Numerous studies have found that postpartum depression has a number of negative effects. Mothers who experience depression are more likely to exhibit hostile levels of behavior towards their infants, including irritability, yelling, and hitting or shaking the child. They are also less likely to engage in positive interactions with their baby, such as playing with and reading to the child, being affectionate, and continuing to breastfeed. Furthermore, depression can result in decreased attention to pediatric preventive practices such as using a car seat, having a smoke detector, and placing the infant on their back to sleep. Depressed mothers are also more likely to physically abuse their babies, and their babies are at higher risk of accidental injury. Children of depressed mothers continue to feel the effects later in life, as one study found that at age 11 they have significantly lower IQ scores, more attention problems, and more difficulties with math. In fact, the correlation between depression and abuse extends backwards as well: depressed mothers are often themselves victims of abuse or violence. The evidence indicates that maternal depression is a serious condition with effects that extend well beyond the first months of an infant's life.
Strategies for Local Communities
There are a number of strategies that local communities can develop to address the issue of maternal depression:
1. Public Awareness and Education: It is important that professional care givers and mothers, as well as family members and friends, to be educated about maternal depression. Healthcare providers should make sure that expecting mothers are aware of the condition. Many resources can be used to educate the population including brochures, child birth classes, and public awareness campaigns. Link to Public Awareness in Other StatesWashington StateLink to Brochure Mental Health association of MinnesotaLink to Educational Material from Minnesota Department of Health
2. Screening: The American Academy of Obstetricians and Gynecology recommends screening at six weeks following delivery; however, additional screening postpartum (including during at-home visits), as well as prenatal screening, is recommended. When screening for perinatal depression, clinicians should utilize a standardized tool. The most common such tool is the Edinburgh Postnatal Depression Scale (EPDS), the sensitivity, specificity, and predictive values of which have been confirmed by researchers. Other tools include the Postpartum Depression Screening Scale, the Center for Epidemiological Studies Depression Scale, and the Beck Depression Inventory-II.Link to EPDS
3. Treatment: There are a variety of treatments available for maternal depression. Some women prefer to treat it with antidepressants and anxiety medications, as well as hormone therapy, but there are also a number of non-pharmacological treatments. These include interpersonal therapy, cognitive behavioral therapy, group therapy, interaction coaching for at-risk parents, home visiting, and parent education.LinksInterpersonal Therapy Cognitive Behavioral Therapy
Local Findings
Specifically within North Carolina, a group of four student researchers found that a major barrier to providing adequate treatment for postpartum depression was inability to serve Spanish-speaking individuals. North Carolina's Hispanic population tripled from 1990 to 2000 and continues to grow. Furthermore, rates of depression are higher among Hispanics, especially those who speak only Spanish. This indicates that employing bilingual, bicultural clinicians, rather than relying on translators, is a logical first step in addressing this issue. However, another possibility is that reevaluating the cultural appropriateness of screening tools may be in order.
Resources
Postpartum Support International
Depression After Delivery1.800.944.4PPD (to request information packet)
Online PPD Support Group
The Postpartum Stress Center
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