Motherhood and Depression

By: Garry Cooper, LCSW

Reprinted with permission from Psychotherapy Networker magazine. Copyright, Psychotherapy Networker, Inc.

 

An editorial in the Journal of the American Medical Association (JAMA) of December 6, 2006, shows how far we’ve come since the days when the visions of the glowing pregnant woman and the happy new mother were accepted without question. The accumulating research showing how often major depression and even psychosis strikes these women, says the editorial, “emphasizes the importance of recognizing childbearing as a potent health factor in the life course of women.” The editorial comes at the same time that new guidelines for Britain’s National Health Service advise health care professionals to inquire about pregnant and new mothers’ mental health.

The most recent study on the subject, which triggered the JAMA editorial and is presented in the same issue, finds that among more than 630,000 Danish women who’d given birth for the first time, 1,171 were psychiatrically hospitalized and 1,369 sought outpatient mental help in the first 12 months after birth. Comparing the mental state of these mothers with that of more than 2 million other Danes, the study firmly concluded that pregnancy poses a significant mental health risk.

The most critical periods for serious mood disorders and psychosis, the study reports, are 10 to 19 days after birth and 0 to 9 days, although the first 90 days all show an elevated risk. The increased risk for depression for recent mothers continues for up to 6 months after birth. More ominously, it concludes that the number of depressed mothers is probably underrepresented, since an estimated 40 to 50 percent of postnatal depression cases go undetected.

The incidence of undetected depression is supported in a study of depression during pregnancy reported in last August’s General Hospital Psychiatry. Led by University of Michigan psychologist Heather Flynn, the team assessed 1,837 pregnant women in obstetrics waiting rooms and found that while 276 of them were at risk for depression based on history or current symptom status, only 52 were receiving any treatment.

Even minor depression has a profound effect on mothers and on their babies’ physical and cognitive development. This year, New Jersey began requiring every health care professional who provides postnatal care to screen for depression for up to a year following birth, and the JAMA editorial calls for the entire country to adopt mandatory screening. It’s noteworthy, however, that there’s no evidence that screening in and of itself has any impact on depression care or outcomes.