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| COMMENTARY |
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| Year : 2018 | Volume
: 2
| Issue : 1 | Page : 41-42 |
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Postpartum depression: Risk factors and their management
Sharmishtha Shailesh Deshpande
Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| Date of Web Publication | 8-May-2018 |
Correspondence Address:
Sharmishtha Shailesh Deshpande
Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune - 411 041, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | 8 |
DOI: 10.4103/aip.aip_21_18
How to cite this article:
Deshpande SS. Postpartum depression: Risk factors and their management. Ann Indian Psychiatry 2018;2:41-2 |
Postpartum period is one of the most important periods in the life of mother and baby. Biological, psychological and social factors operate in a combined way, resulting in various mental health problems occurring at this stage. In addition to physical stress, significant psychosocial stress is experienced by the mother. Mother or rather both parents are often not adequately prepared for the new tasks in some or the other way. There are educative parental training programs started recently though they are often inadequate.
| Risk Factors | |  |
A recent Indian study [1] has reported common occurrence of mild-to-moderate postpartum depression in up to 20% women. More susceptibility was reported in the presence of prior history of depression, less family support, pregnancy and delivery-related complications, presence of other life adversities including family problems, and birth of baby girl as undesirable gender baby. Similar observations are reiterated by other Indian studies.[2],[3],[4]
Most of these risk factors can be successfully dealt with by educative and counseling work so as to anticipate the difficulties and plan for solutions in advance. Childbirth is a stressful life event, but the couple can anticipate the stresses at least 6 months in advance and thus have time to work on it. In their prospective study, Patel et al.[4] have reported the occurrence of mental health problems during pregnancy itself. Awareness on part of clinicians, patients, and their relatives is necessary, so that they can identify the risk for postpartum depression and work toward its prevention.
Social and cultural beliefs about postpartum period in India are often based on Ayurveda and other age old traditions. A woman usually enjoys special attention and care received from other family members and can rest for sufficient period.
Adequate physical care is often provided and they mostly enjoy a nutritious diet. Postpartum lack of care/neglect is emotionally traumatic for women and has lasting impact on their mental health. This has been reported in a cultural epidemiological study by Paralikar et al.[5] Pregnancy and menstruation related problems were reported as perceived cause for medically unexplained fatigue and weakness by almost half of the ladies even after many years of childbirth. Poor interpersonal relationships and unavailability of adequate support often turn out be harmful for the female's physical and mental health.
With recent sociocultural change and emergence of nuclear families, social and emotional support has declined.[3] This along with increased work responsibilities can increase the stress in postpartum period for a female. Postpartum depression is common in developed and developing countries and rural and urban areas, and we know that it is due to psychobiological vulnerability of the female in this stage of life.[3],[4],[6]
In some families, gender bias continues to persist. Baby of undesired gender continues to remain as one of the risk factors for postpartum depression. Research studies from Karnataka, Goa, and Tamil Nadu have reported this gender bias.[6],[4],[7] Due to various social and cultural reasons, gender bias persists even in well-educated families. Gender bias viewing females negatively is most likely to cause neglect of maternal health, which in turn will negatively affect the infant's health. This interrelationship between maternal and infant mental health is often not recognized by family members.
Depression in males and females is qualitatively different. Perceived stresses and precipitating causes for depression were found to be significantly different in one of the research studies.[8] Women being more sensitive to interpersonal and emotional stresses could also be more vulnerable in the postpartum period. This is the time when supports and resources of various kinds have to be mobilized; couple relationship is too under stress and interference of significant others is also increased.
| Long Term Impact | | |
Impact and long-term effects of postpartum depression are significant. Apart from hazardous complications due to suicidal and infanticide ideation, damage caused to maternal and infant mental health and relationship is a reason to worry. Although the mother knows various health benefits of breastfeeding, the presence of depressive symptoms may adversely affect breastfeeding of the infant. Hatton et al. assessed the correlation between depressive symptoms and continuation of breastfeeding at 6 and 12 weeks postpartum.[9],[10]
There is a high risk of child abuse and neglect. Long-term impairment of the mother–child relationship and psychiatric or learning disorders are also seen in the children of mothers with postpartum depression.[11],[12] Thus, this benign and apparently self-limiting depression should be effectively managed.
| Management | | |
There is huge research work done in various disciplines such as psychiatry, pediatrics, obstetrics, and nursing care with respect to breastfeeding and maternal outcomes in mothers with postpartum depression.[10],[11],[12] However, in practice, we hardly see cases of mild-to-moderate postpartum depression being referred to the psychiatrist. Only some patients with severe postpartum depression and postpartum psychosis are referred to psychiatrists. Most of the patients with mild-to-moderate depression remain untreated. The large numbers of women having postpartum depression as quoted in various studies continue to suffer silently with their young ones.
Management of postpartum depression is often successful with or without pharmacotherapy. However, there are various obstacles in patients reaching the psychiatrist and taking treatment. Patients, their relatives, as well as members of the medical team are hesitant in accepting psychiatric drug treatment. Concern for ill effects of antidepressants on the baby is more powerful, as one fails to consider effects of untreated depression on baby's future mental health.[13],[14] Negative lasting impact on interpersonal interactions can be triggered on account of gender-related issues and distorted cognition due to postpartum depression.
Unhappy marriage is another important factor. Entire family needs to be positively prepared for arrival, which needs to be addressed before arrival of the baby of either sex baby, each member knowing his/her responsibility. Family counseling along with couple counseling is deemed essential in the Indian setting.
| Possible Solutions | | |
Obstetrician's awareness about signs and symptoms of depression along with importance of its treatment is of utmost importance. Myths about side effects of antidepressants and harmful effects of nontreatment should be known to clinicians, patients, and their relatives. Nonpharmacological treatments could also be effective and should be tried by psychiatrists. Long-term positive effect of building a happy and mentally healthy family should be aimed at jointly by patient and clinicians. Primary prevention of postpartum depression is likely to be possible with this integrated approach for mental health.
| References | | |
| 1. | Modi VP, Parikh MN, Valipay SK. Prevalence of postpartum depression and correlation with risk factors. Ann Indian Psychiatry 2018;2:27-32.  [Full text] |
| 2. | Ghosh A, Goswami S. Evaluation of postpartum depression in a tertiary hospital. J Obstet Gynaecol India 2011;61:528-30. |
| 3. | Savarimuthu RJ, Ezhilarasu P, Charles H, Antonisamy B, Kurian S, Jacob KS, et al. Post-partum depression in the community: A qualitative study from rural South India. Int J Soc Psychiatry 2010;56:94-102. |
| 4. | Patel V, Rodrigues M, DeSouza N. Gender, poverty, and postnatal depression: A study of mothers in Goa, India. Am J Psychiatry 2002;159:43-7. |
| 5. | Paralikar V, Agashe M, Sarmukaddam S, Deshpande S, Goyal V, Weiss MG, et al. Cultural epidemiology of neurasthenia spectrum disorders in four general hospital outpatient clinics of urban Pune, India. Transcult Psychiatry 2011;48:257-83. |
| 6. | Hegde S, Latha KS, Bhat SM, Sharma PS, Kamath A, Shetty AK. Postpartum depression: Prevalence and associated factors among women in India. J Womens Health Issues Care 2012;1:1. |
| 7. | Chandran M, Tharyan P, Muliyil J, Abraham S. Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors. Br J Psychiatry 2002;181:499-504. |
| 8. | Deshpande SS, Kalmegh B, Patil PN, Ghate MR, Sarmukaddam S, Paralikar VP, et al. Stresses and disability in depression across gender. Depress Res Treat 2014;2014:735307. |
| 9. | Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: A systematic review. Bull World Health Organ 2012;90:139G-149G. |
| 10. | Hatton DC, Harrison-Hohner J, Coste S, Dorato V, Curet LB, McCarron DA, et al. Symptoms of postpartum depression and breastfeeding. J Hum Lact 2005;21:444-9. |
| 11. | Henderson JJ, Evans SF, Straton JA, Priest SR, Hagan R. Impact of postnatal depression on breastfeeding duration. Birth 2003;30:175-80. |
| 12. | Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. Acta Paediatr 2015;104:96-113. |
| 13. | Nonacs R, Cohen LS. Postpartum mood disorders: Diagnosis and treatment guidelines. J Clin Psychiatry 1998;59 Suppl 2:34-40. |
| 14. | Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: Clinical, psychological and pharmacological options. Int J Womens Health 2010;3:1-4. |
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