Postpartum Depression Research Paper

Postpartum Depression
Postpartum Depression: An Increasing Issue in Women’s Health
Kristina Hyland
KINS 3120 Section 2
13 November 2013

The purpose of this paper is to provide an overview of a common and increasing issue
among women following the birth of a child, Postpartum Depression (PPD). This disorder will
be discussed in terms of the signs and symptoms, characteristics of influence, complications and
consequences, and methods of testing and the diagnosis process. In addition, prevention,
treatment, and the recovery process associated with PPD is discussed.
Introduction
Among women of childbearing age depression has become one of the most disabling
disorders among women aged 15-44 around the world (Dennis, Heaman, &Vigod, 2012;
Shapiro, Fraser & Séguin, 2012). Postpartum Depression (PPD) can be described as clinical
depression that occurs during the first year following the birth of a child (Abbasi, Chuang,
Dagher, Zhu, Kjerulff, 2013; Dennis et al., 2012). PPD can occur at any time within this period,
from several days to a year after childbirth (Cabrera & Schub, 2014). During the postpartum
period, women become more receptive to depression, which affects about 10 to 15% of mothers
(Abbasi et al., 2013; Center for Disease Control and Prevention [CDC], 2008; Grace, Robertson,
Stewart, Wallington, 2004). The prevalence of PPD at 6 months during the postpartum period
has ranged from 9.1% to 38.2% (Dennis et al., 2012). Among women who have suffered from
PPD following a previous pregnancy, prevalence rates show an increase to a 41% chance of
developing the disorder with a succeeding birth (American Psychiatric Association [APA],
2014). An analysis of all prevalence studies found that 7.1% of women had a major depressive
episode during the first 12 weeks and this increased to 19.2% when minor depression was
included (Dennis et al., 2012). “PPD has been called “the most significant obstetrical
complication after delivery” and was recently elevated to a “global health challenge” by the
World Health Organization and the March of Dimes” (El-Ibiary et al., 2013).

Signs and Symptoms
The period following birth is usually associated with various challenges that can lead to feelings
of frustration, anxiety, sadness, and exhaustion (Cabrera & Schub, 2014). These symptoms are
known to be normal reactions to the birth of a child, but when persisting for several weeks or
months these can be the warning sign of an underlying case of PPD. As this is true, these
common behavioral features associated with the prenatal and postnatal period causes many cases
of PPD to go undetected (Grace et al., 2004). Tearfulness, hopelessness, feelings of guilt, lack of
appetite, suicidal thoughts, disturbed sleep, feelings of inadequacy and inability to cope with
child, poor concentration and memory, fatigue and irritability are all prominent symptoms of
PPD (Grace et al., 2004). Many women who are affected by PPD also see themselves as bad,
inadequate, or unloving mothers (Grace et al., 2004). To meet the criteria of PPD, one must
experience symptoms for at least 2 weeks and they must directly interfere with everyday life
(Grace et al., 2004).
The signs and symptoms of PPD overlap with two similar psychiatric mood disorders and
these must be ruled out by physicians during the diagnosis process (Bobo & Yawn, 2014). PPD
is midway on the severity continuum of postpartum affective disorders, between postpartum
blues and postpartum psychosis (Cabrera & Schub, 2014; Grace et al., 2004). Postpartum blues is
a mild depressive episode that is characterized by symptoms of sadness, emotional instability,
anxiety and disturbance of sleep and appetite (Bobo & Yawn, 2014; Cabrera & Schub, 2014;
Grace et al., 2004). This disorder occurs within the first couple of days after delivery and can
persist for a few hours to several days, but no more than two weeks (Bobo & Yawn, 2014;
Cabrera & Schub, 2014; Grace et al., 2004). Postpartum blues is the most common mood
disturbance with a 30-75% prevalence rate (Grace et al., 2004). There is no treatment for

postpartum blues other than simple reassurance from those close to the afflicted mother (Grace et
al., 2004). In some cases postpartum blues gradually transforms into the more serious PPD
(Bobo & Yawn, 2014; Grace et al., 2004). Postpartum psychosis is a severe form of bipolar
disorder that is characterized by extreme mood swings, mania, and hallucinations (Cabrera &
Schub, 2014). Postpartum psychosis is less common with a prevalence rate of 0.1-0.2% (Grace et
al., 2004). This severe postpartum disorder appears within the first few weeks following
delivery and can last from several weeks to months (Bobo & Yawn; Grace et al., 2004). The
symptoms for this form of postnatal illness are depression, disorganized behavior, constant
changes in mood, and delusions and hallucination (Bobo & Yawn, 2014; Grace et al., 2004). In
many cases, hospitalization is required to treat this disabling disorder (Bobo & Yawn, 2014;
Grace et al., 2004). Studies have found that mood disorders following childbirth are not
significantly different from affective illnesses that occur among women at other times (Grace et
al., 2004).
Characteristics of Influence
Although the manner of causation is unknown, PPD it is thought to be multifactorial
including social, demographic, obstetric, biological, hormonal, psychiatric, and genetic features
(Bobo & Yawn, 2014; El-Ibiary et al., 2013; Shapiro, Fraser & Séguin, 2012). Epidemiologic
studies and various analyses of predictive studies have been organized to determine PPD risk
factors (Dennis et al., 2012). The most consistent risk factors determined include depression and
or anxiety during pregnancy, history of psychiatric illness, postpartum blues, childcare stress,
marital conflict, and lack of social support (Abbasi et al., 2013; Collingwood, 2013; Dennis et
al., 2012; El-Ibiary et al., 2013; Liu & Tronick, 2013). Demographic factors are not determined
to be significantly linked to PPD, but some aspects can be considered weak risk factors like

unwanted or unplanned pregnancy, low socio-economic status and being single (Abbasi et al.,
2013; El-Ibiary et al., 2013; El-Hachem et al., 2014). Along with this, studies have found that
low levels of education were more frequently observed among women who developed PPD
(Abbasi et al., 2013; El-Hachem et al., 2014). Other risk factors such as difficult pregnancies,
obstetrical complications, season of delivery and unsuccessful breastfeeding are noted as well
(Collingwood, 2013; El-Ibiary et al., 2013). Women at the highest risk for PPD are those with a
previous history of postpartum psychosis, history of PPD and those who experienced depressive
symptoms while pregnant (Abbasi et al., 2013; El-Ibiary et al., 2013; El-Hachem et al., 2014).
Genetic factors have been implicated as one of the probable causes of PPD, as
determined by familial, twin, and adoption studies (Shapiro, Fraser & Séguin, 2012). It is
estimated that about 40% to 50% of the risk for depression is genetic (Shapiro et al., 2012).
Variations of genetic adaptive traits have been recognized including those associated with
serotonin transport, glucocorticoid receptor sensitivity, and brain derived neurotropic factor (El-
Ibiary et al., 2013). The majority of studies have addressed the influence of the 5-HTT (serotonin
transporter) gene on depression (Shapiro et al., 2012). The 5-HTT gene alters the absorption of
5-HT (serotonin) at brain synapses, a principal neurobiological feature of depression (Shapiro et
al., 2012). Following meta-analyses conducted by Shapiro, Fraser & Séguin (2012) there is
significant reason to deduce that the 5-HTT gene is related to depression women experience in
the period preceding birth. The pilot data of a study conducted by El-Ibiary and colleagues
(2013) suggests that DNA variants in the HTR2A, a subtype of 5-HTT, gene may also be
responsible for the onset of PPD. A genetic analysis revealed DNA variations at several
locations, which may be pertinent to the development of PPD, most notably the 5HT2A
serotonin receptor (El-Ibiary et al., 2013). Studies have determined that genetic variants in

HTR2A, the gene that encodes the 5HT2A receptor, may be associated with PPD (El-Ibiary et
al., 2013). Recent and previous evidence has identified a significant relationship between PPD
and the 5HT2A receptor causing alterations in serotonin activity within the nervous system (El-
Ibiary et al., 2013). Research has also found an association between PPD and the genes involved
in glucocorticoid response (FKBP5), estrogen activity (ESR1) and, to a lesser extent,
progesterone effects (PGR) (El-Ibiary el at., 2013). There has also been a reported association
between the serotonin transporter linked polymorphic region (5-HTTLPR) and PPD, but was
limited to women with a previous history of mental illness (El-Ibiary et al., 2013). Although
these specific genes have been identified as having a relationship with the development of PPD,
further research is needed to signify these findings and to determine whether other
polymorphisms may influence PPD.
PPD was previously thought to be caused by the decline in reproductive hormones that
immediately follows delivery, even though the levels of these hormones normalize within the
first subsequent week (El-Ibiary et al., 2013). Other biological factors have also been proposed,
such as deficiencies in monoamines and related enzymes (El-Ibiary et al., 2013). While the
characteristics of PPD are closely related to depression outside of the postpartum period, certain
biologic features distinguish PPD (Shapiro et al., 2012). In their study, Shapiro and colleagues
(2012) explore the previous assumptions that hormonal changes associated with giving birth
contribute to mood alterations in vulnerable women. The study found a decreased susceptibility
to depression in women during hormone stability, this suggesting that PPD may originate, in
part, from hormonal changes associated with childbirth (Shapiro et al., 2012). During pregnancy
cortisol levels double, while progesterone and estrogen levels increase significantly, then
abruptly return to normal after birth (Shapiro et al., 2012). Evidence received following

experimental analysis of this phenomenon suggests that women who develop PPD may be
sensitive to these hormonal fluctuations (Shapiro et al., 2012).
Receiving social support through a stressful time is thought to be a positive protective
factor, therefor, when a mother lacks support this increases a woman’s chance of developing
PPD (Grace et al., 2004). The idea of social support is a multidimensional concept as sources can
be derived from a spouse, relatives, friends, as well as co-workers (Grace et al., 2004). Various
studies have shown a negative relationship between PPD and emotional and instrumental support
during pregnancy (Grace et al., 2004). The results of a Social Support Survey conducted by El-
Ibiary and colleagues (2013) revealed that those who were depressed scored significantly lower
in the domains of emotional, informational, tangible, affectionate, and positive social support. In
comparison of psychosocial variables, a significant association between PPD and distressed
relationships was revealed (El-Ibiary et al., 2013; Rich-Edwards et al., 2006). Having marital
problems during and following pregnancy, this which leads to feelings of lack of support, have
been associated with increased risk of PPD (Grace et al., 2004). Women, who perceive
themselves as having low levels of social support, even if this was not true, are also at high risk
for PPD (Grace et al., 2004).
To further determine risk factors for PPD, Rich-Edwards and colleagues (2006)
incorporated a measure of financial instability that significantly increased the risk of PPD
symptoms. This gives an explanation of the proposed higher risk among African American
mothers and much of the heightened risk seen in Hispanic mothers, as well as a portion of the
risk associated among adolescents (Rich-Edwards et al., 2006). A higher risk of PPD among
minority women seems to result from financial hardship which in turn may lead to poor
pregnancy outcomes (Rich-Edwards et al., 2006). Although mothers who were not working and

mothers on maternity leave were at the same risk as employed mothers, women looking for work
were more likely to have PPD symptoms (Rich-Edwards et al., 2006). Research has found that
rates of unemployment, financial issues, and low education are higher among women with PPD
(Rich-Edwards et al., 2006). Financial hardship was a risk factor for PPD whether or not women
had experienced prior depressive symptoms, suggesting that poverty is an influence on PPD
rather than an effect of the disorder (Rich-Edwards et al., 2006).
Adolescents have a significantly increased risk of PPD with prevalence estimates ranging
from 26 % to over 50 % (Bobo & Yawn, 2014; Nunes & Phipps, 2013). A higher prevalence of
PPD has been observed among mothers under the age of 25 (Nunes & Phipps, 2013; Rich-
Edwards et al., 2006). The higher risk of PPD symptoms associated with young age is largely
explained by financial instability, unwanted pregnancy, lack of a partner, family issues, little
social support, and low self-esteem (Nunes & Phipps, 2013; Rich-Edwards et al., 2006).
Evidence determined based on predictive models found that adolescent PPD is most influenced
by social support alone compared to adult PPD, which is more influenced by intention, race,
stress, financial status, and social support (Nunes & Phipps, 2013).
Having a very difficult pregnancy is also seen as a strong predictor for PPD, as well as
expressing caring for the child as extremely difficult (El-Ibiary et al., 2013). PPD has been linked
to severe obstetrical complications during pregnancy and at delivery such as adverse birth and
neonatal outcomes (Shapiro et al., 2012). These complications include preeclampsia,
hyperemesis, premature labor, caesarean section, instrumental delivery, premature delivery and
excessive bleeding intrapartum (Grace et al., 2004). Women who delivered a low birth weight
infant had a three times higher risk of developing PPD (Rich-Edwards et al., 2006). The results

of 16 large scale studies on 9,500 women determined that these complications have a small but
notable effect on the development of PPD (Grace et al., 2004).
International studies have found an increased risk of PPD following an unintended
pregnancy, while this is true, there is minimal data on this relationship in the U.S. (United States)
samples (Abbasi et al., 2013). An estimated 49% of pregnancies in the U.S. each year are
unintended, making unintended pregnancy a common occurrence today (Mercier, Garrett, Thorp
& Siega-Riz, 2013). Although it may be a cultural perception to believe the majority of these
pregnancies end in abortion, 58% result in a live birth (Mercier et al., 2013). A woman with an
unwanted pregnancy has a higher risk of developing PPD in comparison with mistimed and
intended pregnancy at 3 and 12 months (Mercier et al., 2013). When all three are combined for
unintended pregnancy, there is a minimally increased chance of development at 3 months and a
two times increase at 12 months. Nearly half of the women with an unintended pregnancy had
incomes below the 300% poverty level, while only 19% of the women with intended pregnancy
were in this group (Mercier et al., 2013). Women who experienced an unintended pregnancy
were less likely to be white and be married in comparison to those who had an intended
pregnancy (Mercier et al., 2013). Unintended pregnancy may have a long-term effect on health
and wellbeing, even though the woman chooses to follow through with the pregnancy (Mercier
et al., 2013).
Based on current research, the strongest predictors of postpartum depression are having a
previous history of depressive illness or experiencing depression or anxiety during pregnancy
(Dennis et al., 2012; El-Ibiary et al., 2013; Grace et al., 2004; Rich-Edwards et al., 2006). Thirty-
one percent of women with prenatal depressive symptoms also suffered from PPD symptoms,
while only 6% of women who lacked these symptoms experienced PPD (Rich-Edwards et al.,

2006). In a study conducted by Liu & Tronick (2013) prenatal depression was found to be a
major predictor for PPD diagnosis for all racial/ethnic groups analyzed within the study. Having
higher levels of anxiety during pregnancy was a predictor of increased levels of PPD symptoms
(Grace et al., 2004). Women with a past history of a psychiatric illness are at a significantly
increased risk of PPD (Grace et al., 2004). Studies consistently show that having previously
experienced depressive symptoms at any time, not just in relation to childbirth, leads to an
increased risk of PPD (Grace et al., 2004; El-Ibiary et al., 2013). Having a positive family history
of any psychiatric illness further substantially confers risk of PPD (Grace et al., 2004).
Complications and Consequences
If left untreated, the consequences of PPD can be serious for not only the mother, but her
newborn, and the entire family (El-Ibiary et al., 2013; Grace et al., 2004; Nunes & Phipps, 2013).
Mothers who are depressed may experience unnecessary suffering, deteriorating health status,
marital discord, and suicidal ideation (El-Ibiary et al., 2013; Shapiro et al., 2012). PPD can lead
to persistent depression, intense sadness, and interrupted interaction with child, suicide and
infanticide in rare cases (Beck, 2002; Cabrera & Schub, 2014; El-Hachem et al., 2014; Shapiro et
al., 2012). Women may also experience intense irritability and anger, anxiety, feelings of guilt,
and a sense of being unable to care for the baby (Abbasi et al., 2013; Bobo & Yawn, 2014).
Additionally, PPD can have physical manifestations such as headache, fatigue, decrease appetite,
insomnia and lack of energy (Abbasi et al., 2013; Bobo & Yawn, 2014; Cabrera & Schub, 2014).
The consequences of PPD are particularly worrisome among adolescents due to an increased risk
of birth defects and difficulties parenting in relation to non-adolescent adults (Nunes & Phipps,
2013).

Not only do these deteriorating health and social consequences of PPD have an effect on
the afflicted mother, but have been determined to impact the development of the child as well
(Bobo & Yawn, 2014). The newborns of depressed mothers have been found to have emotional,
cognitive, and physical developmental setbacks (Beck, 2002; Dennis et al., 2012; El-Ibiary et al.,
2013; Grace et al., 2004; Hunington, 2012). PPD was has also been associated with interruptions
in this critical period of bonding for the mother and her newborn child (Abbasi et al., 2013;
Beck, 2002; Bobo, Yawn, 2014). A meta-synthesis analyzed by Beck (2002) found that PPD had
a moderate to severe effect on the interaction between mother and child following birth. Infants
of depressed mothers were seen to be fussier and make fewer positive responses, such as facial
expressions and vocalizations (Beck, 2002; Dennis et al., 2012). Research has also suggested an
association between PPD and physical and mental problems in the child of the depressed (Bobo
& Yawn, 2014; Shapiro et al., 2012). Various studies have found that mothers affected by PPD
have a tendency to be more detached, antagonistic, critical, and less sensitive toward their child
(Shapiro et al., 2012). Children affected by these consequences may develop an insecure
attachment with their mother, this which could result in sleep pattern interruptions, language and
cognitive developmental delays and poor regulation of emotions (Beck, 2002; Dennis et al.,
2012; Grace et al., 2004; Shapiro et al., 2012). Studies have also found that children who were
exposed to PPD symptoms since birth had a larger amygdala and an increased cortisol response
to stress (Shapiro et al., 2012).
In women who are affected by PPD the majority of cases dissipate within months, but for
many this is the trigger that fosters recurrent or chronic episodes of depression (Grace et al.,
2004). Women who have previously suffered from PPD are also at an increased chance of
suffering further episodes following another birth (Bobo & Yawn, 2014; Grace et al., 2004).

After the occurrence of one postpartum episode a woman has a 25% chance of experiencing a
reoccurrence (Grace et al., 2004). PPD can, in severe and recurring cases, be a risk factor for
maternal suicide, this which accounts for up to 20% of deaths that occur within the postpartum
period (Bobo & Yawn, 2014).
Methods of Testing and the Diagnosis Process
As PPD is an increasingly significant health concern to not only the affected mother, but
her newborn child, it is imperative that women and physicians know the symptoms associated
with this illness and employ methods to adequately construct a diagnosis. Screening for PPD can
drastically improve identification and, when accompanied by a diagnostic and follow-up
program, can lead to improved outcomes (Bobo & Yawn, 2014). Clinical diagnosis for PPD can
pose a difficult challenge as depressive symptoms and the normal changes of motherhood are
very similar in appearance (Grace et al., 2004). While severe cases are easily detected, the less
severe may be dismissed as normal or natural outcomes of childbirth, this which may have
negative effects on both mother and child (Grace et al., 2004).The National Institute for Health
and Care Excellence (NICE) guidelines and The Scottish Intercollegiate Guidelines Network
(SIGN) for the detection and management of PPD state that screening should be done between 4
to 6 weeks and 3 to 4 months after delivery (El-Hachem et al., 2014). The American College of
Obstetricians and Gynecologists (ACOG) has recognized screening as an important component
of postpartum care (Beck, 2002). This is evident as studies have shown that up to an alarming
50% of PPD cases go undetected and only 49% of mother who felt severely depressed got help
(Beck, 2002; Bobo & Yawn, 2014). Screening for depression is recommended by the US
Preventive Services Task Force, but standard PPD screening has not been widely accepted
throughout the population (Bobo & Yawn, 2014).

Early recognition is one of the major challenges in dealing with this mood disorder
(Beck, 2002). The growing evidence of the devastating effects of PPD further emphasizes the
need to screen women for their risk of developing this disorder (Beck, 2002). In response to this
The Postpartum Depression Predictors Inventory (PDPI) was formed from the findings of two
meta-analyses of PPD risk factors (Beck, 2002). The PDPI is a checklist that consists of eight
risk factors determined to be significantly associated with PPD (Beck, 2002). These predictors
are prenatal depression, prenatal anxiety, and history of previous depression, social support,
marital satisfaction, life stress, child care stress, and maternity blues (Beck, 2002). This
inventory check list can be used both during pregnancy and following the birth of the child to
determine the likelihood that a woman will develop PPD (Beck, 2002). This model has been
employed not only throughout the United States, but has also been used in Canada and Iceland
(Beck, 2002). As it was developed based on previous findings this model must be periodically
revised in relation to changing evidence to add new data and to remove that which is no longer
significant (Beck, 2002).
The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening
instrument for PPD (El-Hachem et al., 2014). The EPDS can be used for women with a past
depression and for those who currently report or appear to be depressed (Grace et al., 2004). The
EPDS is a self-administered questionnaire with 10 items, and is translated and verified in
English, French and Arabic (Bobo & Yawn, 2014; El-Hachem et al., 2014). This questionnaire
does not require an extensive knowledge base or a lengthy time period to complete, as it can be
conducted in an average of 5 minutes (Bobo &Yawn; El-Hachem et al., 2014). Women who
complete the EPDS and score greater than or equal to 13 in terms of the scale are indicated of
having a high risk of PPD (Bobo & Yawn, 2014). The EPDS has significant power in detecting

women complaining of a depressive episode between 4 and 8 weeks postpartum and is thus
considered a good tool for screening of PPD (El-Hachem et al., 2014).
While prenatal and postnatal screening tools to identify women with a high risk of PPD
have been developed, there is no specific tool tailored to adolescents (Nunes & Phipps, 2013).
Due to differences in life circumstances, screening instruments developed for the general
population of pregnant women may not provide accurate results for adolescents (Nunes &
Phipps, 2013). In a study Nunes & Phipps (2013) found that when applied to adolescent
populations, their predictive model developed for the general population of pregnant women did
not offer accurate results (Nunes & Phipps, 2013). This suggests that current screening tools may
not be adequate for prenatal risk assessment of PPD among pregnant adolescents (Nunes &
Phipps, 2013). The differences between ages supports the idea that screening for women at risk
of PPD should be specific to maternal age (Nunes & Phipps, 2013). The development of age
specific screening tools should consider the role of coping, self-esteem, and future aspirations
(Nunes & Phipps, 2013).
A review of the current literature has determined that there is a knowledge gap between
the use of appropriate instruments for assessing PPD within different cultural groups (Grace et
al., 2004). Close attention should be given to immigrant women as their interactions and access
to health care services and opportunities of social support may differ in comparison to other
ethnic groups (Grace et al., 2004).
These screening measures provide a significant basis for physicians to conduct further
evaluation to determine for PPD, but should not be a substitute for extensive clinical interviews
and diagnostic testing (Bobo & Yawn, 2014). The clinical evaluation objectives are as follows:
(1) to determine that diagnostic criteria is met; (2) to assess the risk of suicide and infanticide;

(3) to differentiate between medical or other mood disorders; and (4) to establish comorbidities
or associated symptoms (Bobo & Yawn, 2014). During the evaluation process prescription and
over-the-counter medications, smoking status and drug use should also be documented as well as
throughout treatment (Bobo & Yawn, 2014). The effect of PPD symptoms on the functional
statues of the mother should be addressed as well (Bobo & Yawn, 2014). Other contributing
factors such as life stressors, social and financial support, relationship qualities are also
important to determine (Bobo & Yawn, 2014). A medical history evaluation of the woman
should be conducted, including chronic or active medical concerns, psychiatric diagnoses, and
treatment (Bobo & Yawn, 2014). The specific aspects of previous treatments are included in this
assessment as well as the personal and family history of PPD and postpartum psychosis (Bobo &
Yawn, 2014).
Prevention, Treatment and Recovery
Early identification of women who may be at risk for PPD aids in the prevention and
reduction of depressive symptoms (Grace et al., 2004; Nunes & Phipps, 2013). The potential risk
factors for PPD can be determined during routine pregnancy care; therefore, it is imperative that
healthcare providers and women themselves become educated about these risk factors (Grace et
al., 2004). For physicians, it is important to conduct a thorough clinical history of the mother,
which specifically asks about previous instances or feelings of depression (Grace et al., 2004). It
is also important to gather information of prenatal depression, this which may be difficult,
particularly if the woman does not view these feelings as being caused by depression, but rather
a normalcy of pregnancy (Grace et al., 2004). It is very likely that many women may have
experienced symptoms previously, but never sought treatment (Grace et al., 2004). A clinician

having an increased awareness of mood during pregnancy and asking women how they feel may
be helpful in preventing the onset of PPD (Grace et al., 2004).
Clinicians should identify women at higher risk for PPD so to conduct closer follow-up
and intervention where needed (Grace et al., 2004). These vulnerable groups may include women
experiencing marital strife, those who have experienced stressful life events, those from lower
socioeconomic status, and those under financial pressure (Grace et al., 2004). As unintended
pregnancy is a risk factor for PPD clinical providers should consider asking about pregnancy
intention at early prenatal visits (Mercier et al., 2013). Women who report an unintended or
unwanted pregnancy may benefit from earlier or more specified screening for depression both
during and after pregnancy (Mercier et al., 2013). Close attention should be given to immigrant
women as their access to health care services and opportunities of social networks and support
may differ from other groups (Grace et al., 2004). In certain cultures there may be a relationship
between child gender and PPD and physicians should ask the woman how she feels about this so
to determine if she is at risk for PPD (Grace et al., 2004). Based on previous findings, prenatal
assessment of social support among pregnant adolescents may be very useful in targeting
interventions to treat and prevent PPD (Nunes & Phipps, 2013). A recent study argues that
receiving informational support from a large number of social network members was protective
against PPD (Grace et al., 2004). A supportive relationship with the father has also been
determined to help alleviate the stresses of being a new mother (Grace et al., 2004).
As one of the most common disorder among women following the birth of a child, it is
imperative that women who screen positive for PPD receive immediate treatment (Bobo &
Yawn, 2014). The treatment for PPD is decided based on the severity of symptoms, preference of
patient, previous response to treatment(s), availability of resources, and choices about breast

feeding (Bobo & Yawn, 2014). Involvement of the woman’s support system in the treatment
process may help the mother feel less stressed with the decision of deciding a treatment (Bobo &
Yawn, 2014). Psychotherapy is known as the first-line treatment option for women with a mild
or moderate case of PPD (Bobo & Yawn, 2014). Cognitive-behavioral therapy and interpersonal
therapy (IPT) are treatment approaches given over 10 to 20 weekly sessions (Bobo & Yawn,
2014). Both of which have been determined to have a moderate to large effect on reducing PPD
symptoms (Bobo & Yawn, 2014). These particular treatment options apply to women
experiencing mild to moderate PPD, including those who are breast-feeding (Bobo & Yawn,
2014). Women with moderate to severe PPD, who are not breast-feeding, may decide to use
antidepressants with or without psychotherapy as treatment (Bobo & Yawn, 2014). This includes
women with previous mild PPD that escaladed and moderate PPD that does not respond well to
psychotherapy (Bobo & Yawn, 2014). There is no particular antidepressant that has shown
significant benefits over others, therefore those that have been helpful in previous cases are
preferred (Bobo & Yawn, 2014). It is recommended that the effective antidepressant be taken up
to 6 months after symptoms dissipate so to prevent relapse (Bobo & Yawn, 2014). There has
been various studies conducted on the relationship between PPD antidepressant treatment and
breast-feeding. Although there have been numerous health benefits associated with breast-
feeding, a woman affected by PPD should weigh the risks of not receiving treatment and the
risks and benefits of antidepressant use while breast-feeding (Bobo & Yawn, 2014). A woman
who is breast-feeding can receive treatment through psychotherapy alone without harming their
baby, but depressive symptoms should be closely monitored (Bobo & Yawn, 2014). If symptoms
continue to worsen following the use of all available treatment options the individual case should

be reevaluated to determine any characteristics that may have been previously missed or
unaddressed (Bobo & Yawn, 2014).
Conclusion
Postpartum depression is a form of clinical depression that can affect a woman at
any time within the first year following the birth of a child. All women are susceptible to
developing PPD, however, there are certain risk factors that make a particular women’s chance
of experiencing this illness significantly more likely. PPD is characterized by persistent physical
and emotional challenges that interfere with the ability of the mother to care for her child and
carry out everyday tasks. Women who are affected may experience various symptoms closely
associated with PPD, such as frustration, sadness, despondency, loss of appetite, suicidal
ideation, sleep disturbances, poor concentration and memory, fatigue and irritability. The single
cause of PPD is unknown, but is believed to be multifactorial in which various influencing
characteristics contribute to its subsequent development. Treatment is readily available and
comes in various forms, that which depends on the extent of symptoms, patient preference,
previous treatment response and the availability of resources. However, PPD can be prevented
and the most beneficial way of preventing this disorder is early identification of women at risk.
While there is extensive research on the topic of PPD further research needs to be conducted on
the risk factors to get a better understanding of this broad category of influencing characteristics
as well as the developmental effects of the child and the screening process. Although various
aspects of this disorder are becoming better understood, further knowledge required to prevent
PPD, decrease the rate of development, and to improve the treatment process.

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