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Janet W. Bates
POSTPARTUM DEPRESSION
The postpartum period is a time of unrivaled de-
mands and unique stresses, and is a developmentally
challenging time for new parents even in the best of
circumstances. During a normal postpartum experi-
ence, it is not unusual for new parents to experience
heightened family and family-of-origin issues associ-
ated with the transition to parenthood. For example,
adjustments usually need to be made in areas such as
sleep schedules, employment, and role allocation.
And, even for seasoned parents, there is the adven-
ture of understanding the particular infant’s unique
temperament, needs, vulnerabilities, and strengths.
The experience of depression in the mother during
the postpartum period transforms an already chal-
lenging adventure into a potentially overwhelming
one.
What Is Postpartum Depression?
There are three forms of postpartum depression,
which vary greatly in terms of severity, duration, and
impairment. The least severe (and most common)
type is known as the ‘‘baby blues.’’ This is a mild syn-
drome occurring in up to 80 percent of new mothers.
It usually starts within the first few days following
childbirth and may last from a few hours to several
days. Although distressing, the symptoms (which gen-
erally include episodes of crying, mood swings, and
worry) do not cause significant impairment for the
mother. On the other hand, ‘‘postpartum psychosis’’
is a rare yet very severe psychiatric illness. In such
cases, the symptoms, which include mood distur-
bances along with hallucinations or delusions, cause
major impairment in the new mother’s ability to func-
tion. This illness usually requires that the mother be
hospitalized.
The third type of depression, known as ‘‘postpar-
tum depression,’’ occurs in approximately 15 to 20
percent of women following childbirth. It is a psychi-
atric syndrome, defined by the Diagnostic and Statisti-
cal Manual of Mental Disorders: DSM-IV as dysphoric
mood (or loss of pleasure or interest in usual activi-
ties), coupled with symptoms such as sleep and appe-
tite changes, cognitive disturbances, loss of energy,
and/or recurrent thoughts of death, which co-occur
for at least a two-week period. These symptoms cause
significant distress and/or impairment in the new
mother’s functioning. It is important to note that
these are the same symptoms used to diagnose a
major depression at anytime during a person’s life.
The depressive syndrome is labeled a postpartum de-
pression if the symptoms begin within the first three
months following childbirth. On average, postpartum
depression lasts for about four months, although it
can vary considerably in length.What Causes Postpartum Depression?
Depression during the postpartum period can
best be considered an accident of timing; research has
suggested that the rates, antecedents, course, and
quality of depression during the postpartum period
are similar to episodes experienced at other times in
a woman’s life. Although some research has suggested
that negative life events during pregnancy and follow-
ing delivery (such as financial difficulties, unemploy-
ment, and poor marital adjustment) may be
associated with the onset of postpartum depression in
new mothers, research in the late 1990s identified a
previous instance of major depression as the most sa-
lient risk factor for postpartum depression.What Are the Consequences of
Postpartum Depression?
There has been an abundance of research on the
influence of maternal depression in general on child
outcome. This is for good reason—such research gen-
erally supports the notion that parental psychological
distress (such as depression) is related to the develop-
ment of negative parent-child interaction and family
relationship patterns, which are associated with poor
child outcomes. Depressed mothers as a group pro-
vide more negative self-reports regarding various as-
pects of family life, including dissatisfaction in
relationships with their spouses and children, as well
as stress and uncertainty regarding their own role as
parents. Maternal depression has also been associated
with disruptions in family unit functioning.
Not only are mothers affected by postpartum de-
pression, the children of depressed mothers also ex-
hibit a variety of impairments in social, psychological,
and emotional functioning. More specifically, mater-
nal depression during the postpartum period has312 POSTPARTUM DEPRESSION