Women's Health

Half of postpartum depression cases are not recognized

About 13 percent of women suffer from the anxiety, hopelessness, desolation, and fatigue of postpartum depression (PPD) for the first 3 to 12 months of their children's lives. Yet, primary care physicians fail to recognize more than half of PPD cases, despite the availability of depression screening tools that can expedite diagnosis and treatment. Some women and clinicians may confuse PPD with "baby blues," which occur in more than 80 percent of mothers. However, baby blues begin within hours or days of delivery, are characterized by major mood swings rather than consistent depressive symptoms, and typically disappear 2 to 4 weeks postpartum.

While baby blues and minor depressive symptoms often clear spontaneously, PPD is a persistent form of major depression that develops within the first 2 to 6 months postpartum. Untreated PPD can devastate the mother (who loses her energy or joy in parenting), her child (who often has delayed psychological and cognitive development), and her family (with twice the risk of divorce within 2 years postpartum). In extreme cases, PPD can result in suicide and infanticide. Timely diagnosis and treatment of PPD can interrupt these cycles before damage to mother, child, and family become irreparable, explains Barbara P. Yawn, M.D., M.Sc., of the Olmsted Medical Center and University of Minnesota.

Presence of risk factors—young age, living without a partner, divorce, multiple life stresses, lower socioeconomic status, and history of affective disorders—can identify only 30 to 40 percent of women who will develop significant PPD. Recent studies investigating a broad spectrum of hormones are more promising, but a biochemical test to identify women at risk for PPD does not seem likely in the near future. Yawn and her colleagues have begun enrolling women in a 5-year study to assess the ability of family medicine practices to screen, diagnose, treat, and follow up women with PPD. The study was supported by the Agency for Healthcare Research and Quality (HS14744).

See "Postpartum depression, Part 1: Prevalence and considerations in screening," by Dr. Yawn, in the March 2006 The Female Patient 31, pp. 1-6; and, "Part 2: Practical application and screening options" in the April 2006 The Female Patient 31, pp. 48-52.

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