Postpartum Depression as a Mental Illness: Cause for the Development - Research Paper Example

Introduction Mental illness is very common in the postnatal period. About 85% of women develop some mental disturbance after birth (NHMRC, 2006). The most common form of mental illness is 'postnatal blues' or 'newborn blues' (NHMRC, 2006). This condition is short lived and subsides without any intervention. The next common mental illness is postnatal depression or postpartum depression or PPD which lasts for some weeks and merits attention, intervention and treatment. The worst form of mental illness is postpartum psychosis, which must be differentiated from postpartum depression. In this article, postpartum depression will be discussed. Definition Postpartum depression or PPD may be defined in many ways. The National Health and Medical Research Council or NHMRC (2006) defines PPD as a form of clinical depression occurring in women in months after childbirth. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), PPD is defined as "non-psychotic major depression that has its onset within 4 weeks after delivery" (cited in Mehta and Sheth, 2006). However, many researchers define PPD as "non-psychotic depression having its onset within 6 months of delivery" (Mehta and Sheth, 2006). Statistics The incidence of PND is similar in all races and ethnicities, but in some cultures, it is under-reported because of the stigma tagged to mental illness making women feel ashamed to report mental illness and seek professional advice (NHMRC, 2006). The incidence of PPD in developed countries has been reported to be 12%- 13% (Mehta and Sheth, 2006). Recent studies have reported incidence in United States to be as high as 10-20% (Mehta and Sheth, 2006). Transcultural rates have been estimated to be about 10-15%, the rates being higher amongst adolescent mothers (Mehta and Sheth, 2006). Causes of PPD There is no definite cause for the development of PPD. There are many risk factors associated with this condition and it has been proposed that PPD develops as a result of interplay of these multiple biopsychosocial risk factors (Mehta and Sheth, 2006). Some of the important risk factors include premenstrual mood disorders, depression during pregnancy, history of depression, history of bipolar disorder, poor relationship with partner, poor social support system, social isolation and stressful life events (Mehta and Sheth, 2006). Dramatic fall in the levels of estrogen, cortisol and progesterone within 48 hours of delivery is considered as one of the causes of PND (Nonacs, 2007). Other risk factors include family history of psychological problems, severe 'baby blues', single parenthood, complications during pregnancy and delivery, negative attitude towards life, depressed partner and health problems in the baby (NHMRC, 2006). There are some reports that unplanned pregnancy, unemployment, parents' perceptions of their own upbringing, not able to breast feed, antenatal parental stress, improper coping styles, antenatal thyroid dysfunction, depression in fathers, longer time to conceive, emotional liability in maternity blues and having 2 or more than 2 children are also risk factors for PND (Scottish Intercollegiate Guidelines Network, 2002). Symptoms The most common symptom of PPD is low mood. Depressed mood is present throughout the day during the first 1-2 weeks, but is most prominent in the morning hours. The patient lacks interest in the newborn baby, is often tearful and does not enjoy anything. She suffers from irritability, feelings of guilt, rejection and inadequacy. She lacks concentration and tends to forget things easily. The woman may develop dislike to the baby and feel like harming the little one for no reason. Research has shown that about 50% of women suffering from PND develop thoughts of harming the baby. But, in reality, these mothers seldom harm the baby. Other symptoms of PND include feeling less energetic, disturbed sleep, decreased appetite and decreased sexual drive (Patient.UK, 2006). Diagnosis of PPD In most of the cases, the sufferers of PPD are not aware of their condition and the diagnosis is made based on the symptomatology described by either the patient, family member or any other close associate. Infact, only 1 in 4 women with PPD seek medical help, the rest suffer in silence. According to NHMRC (2006), presence of any of the following four symptoms for a period of atleast 2 weeks is diagnostic of PPD. 1. Feelings: The woman may feel inadequate, have sense of hopelessness, have low mood, feel exhausted, sad, tearful, empty and sad, feel worthless, ashamed and guilty, experience panic or anxiousness, feel fear of being alone. 2. Actions: The woman may have lack of interest in leisure or pleasurable activities, suffer from sleeplessness, excessive sleep, disturbed sleep or nightmares, develop changes in appetite which may be either decreased or increased, have decreased energy, lack of motivation and social withdrawal, have lack of personal and baby hygiene and develop inability to cope up with daily activities. 3. Thoughts: The woman may not be able to think clearly, may not be in a position to take appropriate decisions, lacks concentration, develops poor memory, gets ideas about suicide, feels like running away from everything, worries about discard by partner, worries abnormally too much about harm or death to partner or baby. Part-2: Edinburgh Postnatal Depression Scale There are many tools which have been developed to simplify the diagnosis and screening of PPD. The most commonly used and popular tool is the Edinburgh Postnatal Depression Scale or EPDS. The scale is 100% sensitive and 95.5% specific for PPD (NHMRC, 2006). The tool is easy and in the form of a questionnaire which can be administered to women easily by office staff. The questionnaire consists of 10 questions (Refer Appendix-1). Each question has 4 sets of answers and scores from zero to 3 are given. For questions 1, 2 and 4, the top box is scored as zero and the bottom box as 3. For questions 3, and 5-10, the top box is scored as 3 and the bottom box as zero (Cox, Holden, Sagovsky, 1987). The maximum score in the scale is 30. Scores of 10 and above 10 are indicative of depression (Cox, Holden, Sagovsky, 1987). Answer for Item 10 should always be looked for because it indicates suicidal thoughts (Cox, Holden, Sagovsky, 1987). While answering the scale, the mother should be asked to complete the questionnaire on her own and she should not discuss the answers with others. She must be advised to base her answers on how she felt over the past 7 days. Those who have difficulty in reading and writing English may be helped with a translator (Cox, Holden, Sagovsky, 1987). Part-3: Apparent Life-threatening Event Definition According to the National Institutes of Health (cited in Carolan, 2009), apparent life-threatening event or ALTE is "an episode that is frightening to the observer and is characterized by some combination of apnea (central or obstructive), color change (cyanotic, pallid, erythematous or plethoric) change in muscle tone (usually diminished), and choking or gagging." The clinical presentation of ALTEs is variable and the actual frequency of occurrence of this condition is unknown. Statistics It has been estimated that about 0.5- 6% of health term infants suffer from this condition (Carolan, 2009). Some reports suggest that the incidence is 0.6 cases per 1000 live-born infants suffer from ALTEs (Carolan, 2009). Causes In about 50% of cases of ALTEs, the cause of the event is unknown (Carolan, 2009). In the others, the cause can be attributed to a range of clinical conditions like gastroesophageal reflux disease, pertussis, viral lower respiratory tract infection, meningitis, metabolic disorders, seizures, cardiac dysarrhthymias, nonaccidental trauma, cardiac or airway anomalies, anemia or structural malformations of the central nervous system. Of these, gastroesophageal reflux disease is attributable to about 26% cases of ALTEs (Carolan, 2009). References Carolan, P.L. (2009). Apparent Life-Threatening Events. Emedicine from WebMD. Retrieved on October 4th, 2009 from http://emedicine.medscape.com/article/1418765-overview Cox, J.L., Holden, J.M., and Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786. Figueira, P., Correa, H., Malloy-Diniz, L., Romano-Silva, M.A. (2009). Edinburgh Postnatal Depression Scale for screening in the public health system. Revista de Saúde Pública, 43(1). Retrieved on October 4th, 2009 from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89102009000800012&lng=en&nrm=iso&tlng=en Mehta, A., and Sheth, S. (2006). Postpartum Depression: How to Recognize and Treat This Common Condition. Medscape Pediatrics. Retrieved on October 4th, 2009 from http://www.medscape.com/viewarticle/529390 National Health and Medical Research Council or NHMRC. (2000). Postnatal Depression: Not Just the Baby Blues. Commonwealth of Australia. Retrieved on October 4th, 2009 from http://www.nhmrc.gov.au/publications/synopses/_files/wh30.pdf Nonacs, R.M. (2007). Postpartum Depression. Emedicine from WebMD. Retrieved on October 4th, 2009 from http://emedicine.medscape.com/article/271662-overview Patient.UK. (2006). Postnatal Depression. Retrieved on October 4th, 2009 from www.patient.co.uk/showdoc/40026051 Scottish Intercollegiate Guidelines Network. (2002). Postnatal depression and puerperal psychosis. Section 2: Diagnosis, screening and prevention. Retrieved on October 4th, 2009 from http://www.sign.ac.uk/guidelines/fulltext/60/section2.html Appendix-1 Read More