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Postpartum depression
Postpartum depression
Specialty	Psychiatry, psychotherapy, clinical psychology

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Postpartum depression (PPD), also called postnatal depression, is a type of clinical depression which can affect women, and less frequently men, typically after childbirth. Studies report prevalence rates among women from 5% to 25%, but methodological differences among the studies make the actual prevalence rate unclear. Among men, in particular new fathers, the incidence of postpartum depression has been estimated to be between 1% and 25.5%.^[1] Postpartum depression occurs in women after they have carried a child. Symptoms include sadness, fatigue, changes in sleeping and eating patterns, reduced libido, crying episodes, anxiety, and irritability. Although a number of risk factors have been identified, the causes of PPD are not well understood. Many women recover with a treatment consisting of a support group or counseling.^[2]^[3]

The Edinburgh Postnatal Depression Scale, a standardized self-reported questionnaire, may be used to identify women who have postpartum depression.^[4] If the new mother scores more than 13, she is likely to develop PPD.^[5]

Symptoms

Symptoms of PPD can occur anytime in the first year postpartum.^[6] These include, but are not limited to, the following:

Sadness^[6]
Hopelessness^[6]
Low self-esteem^[6]
Guilt^[6]
A feeling of being overwhelmed
Sleep and eating disturbances^[6]
Inability to be comforted^[6]
Exhaustion^[6]
Emptiness^[6]
Anhedonia^[6]
Social withdrawal^[6]
Low or no energy^[6]
Becoming easily frustrated^[6]
Feeling inadequate in taking care of the baby^[6]
Decreased sex drive^[7]

Onset and duration

Postpartum depression usually begins in the first few months after childbirth. In Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition it is defined as depression with onset within 4 weeks after childbirth. Postpartum depression can also affect women who have suffered a miscarriage.^[8] It usually begins around two weeks after childbirth.^[9] It may last up to several months or even a year.^[10]

Psychosis

Postpartum psychosis is a separate mental health disorder which is sometimes erroneously referred to as postpartum depression. It is less common than PPD, and it involves the onset of psychotic symptoms that may include thought disturbances, delusions, hallucinations and/or disorganized speech or behavior. The prevalence of postpartum psychosis in the general population is 1—2 per 1,000 childbirths, however the rate is 100 times higher in women with bipolar disorder or a previous history of postpartum psychosis. Bipolar disorder and, to a lesser extent, schizophrenia have elevated prevalences in postpartum psychosis.^[11] Previous research looked at the relationship between childbirth and postpartum psychosis. Using data on 54,000 births over a 12-year period, researchers found that psychiatric admissions were seven times more likely in the first 30 days after childbirth than in the prepregnancy period and among patients who developed postpartum psychosis after childbirth, 72%—80% had bipolar disorder or schizoaffective disorder and 12% had schizophrenia. Indicators of a possible bipolar diagnosis include a history of missed or misdiagnosed mood episodes, any previous mania or hypomania, and a family history of bipolar disorder or postpartum psychosis.^[11]

Treatment for Postnatal Psychosis is essential; it will not go away without medical attention.^[6]

Effects on the parent-infant relationship

Postpartum depression may lead mothers to be inconsistent with childcare. Women diagnosed with postpartum depression often focus more on the negative events of childcare, resulting in poor coping strategies (Murray).

There are four groups of coping methods, each divided into a different style of coping subgroups. Avoidance coping is one of the most common strategies used (Murray). It consists of denial and behavioral disengagement subgroups (for example, an avoidant mother might not respond to her baby crying). This strategy however, does not resolve any problems and ends up negatively impacting the mother’s mood, similarly of the other coping strategies used (Honey).

Avoidance coping: denial, behavioral disengagement
Problem-focused coping: active coping, planning, positive reframing
Support seeking coping: emotional support, instrumental support
Venting coping: venting, self-blame

Security

Multiple factors must be considered when evaluating the capacity of a seriously depressed mother to provide a safe-enough caregiving environment that can support the healthy development of her baby and her relationship with that baby.^[12] Such factors, including maternal attachment history, present social supports, insight, and ability to accept help are often best considered by an interdisciplinary professional treatment team that includes infant mental health specialists or other mental health practitioners with experience in working with children and families.

Causes

The etiology of PPD is not well understood. It is sometimes assumed that postpartum depression is caused by a lack of vitamins.^[13] Other studies tend to show that more likely causes are the significant changes in a woman's hormones during pregnancy.^[14] Yet other studies have suggested there is no known correlation between hormones and postpartum mood disorders,^[8] and hormonal treatment has not helped postpartum depression victims. Further, fathers, who are not undergoing profound hormonal changes, suffer PPD at relatively high rates.^[15] Finally, all mothers experience these hormonal changes, yet only about 10–15% suffer PPD. This does not mean, however, that hormones do not play a role in PPD.^[16] For example, in women with a history of PPD, a hormone treatment simulating pregnancy and parturition caused these women to suffer mood symptoms. The same treatment, however, did not cause mood symptoms in women with no history of PPD. One interpretation of these results is that there is a subgroup of women who are vulnerable to hormone changes during pregnancy. Another interpretation is that simulating a pregnancy will trigger PPD in women who are vulnerable to PPD for any of the reasons indicated by Beck's meta-analysis as summarized above.

Profound lifestyle changes brought about by caring for the infant are also frequently claimed to cause PPD, but, again, there is little evidence for this hypothesis. Mothers who have had several previous children without suffering PPD can nonetheless suffer it with their latest child.^[17] Plus, most women experience profound lifestyle changes with their first pregnancy, yet most do not suffer PPD.^{[citation needed]}

In 2009, researchers at the University of California, Irvine, reported that the levels of placental corticotropin-releasing hormone (CRH) during the 25th week of pregnancy may help predict a woman's chances of developing postpartum depression.^[18]

Risk factors

While the causes of PPD are not understood, a number of factors have been suggested to increase the risk of PPD:

Birth-related psychological trauma
Birth-related physiological trauma
Formula feeding rather than breast-feeding^[19]
A history of depression^[19]
Cigarette smoking^[19]
Low self esteem^[20]
Childcare stress^[20]
Prenatal depression during pregnancy^[20]
Prenatal anxiety^[20]
Low social support^[20]
Life stress^[20]
Poor marital relationship^[20]
Infant temperament problems/colic^[20]
Maternity blues^[20]
Single Marital Status^[20]
Low socioeconomic status^[20]
Unplanned/unwanted pregnancy^[20]

Of these, formula feeding, a history of depression, and cigarette smoking have been shown to be additive effects.^[19]

These factors are known to correlate with PPD. "Correlation" in this case means that, for example, high levels of prenatal depression are associated with high levels of postnatal depression, and low levels of prenatal depression are associated with low levels of postnatal depression. But this does not mean the prenatal depression causes postnatal depression—they might both be caused by some third factor. In contrast, some factors, such as lack of social support, almost certainly cause postpartum depression. (The causal role of lack of social support in PPD is strongly suggested by several studies, including O'Hara 1985, Field et al. 1985; and Gotlib et al. 1991.) Anthropologists Kruckman and Stern tested the idea cross culturally, and their pioneering study determined six ways in which postpartum rituals, including the use of the postpartum ritual, la cuarentena, in Chicago Latina mothers, to protect or cushion the expression of mood disorders.^[21]

In addition to Beck’s meta-analysis cited above, other academic studies have shown a correlation between a mother’s race, social class and/or sexual orientation and postpartum depression. In 2006 Segre et al., conducted a study "on the extent to which race/ethnicity is a risk factor" for PPD.^[22] Studying 26,877 postpartum women they found that 15.7% were depressed. Of the women who suffered from PPD, African American women suffered at a rate of 25.2%, American Indian/Native Alaskan women at 22.9%, Caucasian women at 15.5%, Hispanic women at 15.3%, and 11.5% for those reporting Asian/Pacific Islander. Even when "important social factors such as age, income, education, marital status, and baby’s health were controlled, African American women still emerged with significantly increased risk for…PPD".^[22]

Segre et al., also found a correlation between a mother’s social class and PPD. Not surprisingly, women with fewer resources indicate a higher level of postpartum depression and stress than those with more financial resources. Rates of PPD decreased as income increased as follows:^[22] Women with fewer resources are also more likely to have an unintended or unwanted pregnancy, further increasing risk of PPD. Beck (2001) concurs with this, stating that these women are at risk for PPD because they may experience stressors such as financial difficulties. Single mothers of low income may have fewer resources that they have access to while transitioning into motherhood.

Income	PPD rate
<$10,000	24.3%
$10,000-$19,000	20.0%
$20,000-$29,000	18.8%
$30,000-$39,000	15.3%
$40,000-$49,000	13.7%
$50,000+	10.8%

Likewise, a study conducted by Howell et al. in 2006 confirms Segre’s findings that women who are not Caucasian and in lower socioeconomic categories have more symptoms of PPD.^[23]

In a 2007 study conducted by Ross et al., lesbian and bisexual mothers were tested for PPD and then compared with a heterosexual sample. Ross et al. found that "lesbian and bisexual biological mothers had significantly higher Edinburgh Postnatal Depression Scale (EPDS) scores than the…sample of heterosexual women."^[24] The Ross study suggests that PPD may be more common among lesbian and bisexual mothers. From a study conducted in 2005 by Ross, the higher rates of PPD in lesbian/bisexual mothers than heterosexual mothers may be due to less "social support, particularly from their families of origin and…additional stress due to homophobic discrimination" in society.^[25]

Evolutionary psychological

Research suggests that PPD is a functional component of human reproductive decision-making, research supports the notion that PPD declined mothers investment in their offspring.^[26]

Human infants require an extraordinary degree of care. Lack of support and insufficient investment from fathers and/or other family members will increase the costs borne by mothers, whereas infant health problems will reduce the evolutionary benefits to be gained.^[26] If ancestral mothers did not receive enough support from fathers or other family members, they may not have been able to afford raising the new infant without harming any existing children, or damaging their own health (nursing depletes mothers' nutritional stores, placing the health of poorly nourished women in jeopardy).

For mothers suffering inadequate social support or other costly and stressful circumstances, negative emotions directed towards a new infant could serve an important evolved function by causing the mother to reduce her investment in an unaffordable infant, thereby reducing her costs. Numerous studies support the correlation between postpartum depression and lack of social support or other childcare stressors.^[20]^[26] Kruckman, using observations from anthropological field work, suggests that supportive rituals and knowledge, if projected to the mother in a meaningful and sincere fashion, can affect the hypothalamus, pituitary and adrenal function and the production of endocrine signal molecules, and reduce the expression of anxiety or panic in postpartum women.^[27]^[28]

Mothers with postpartum depression can unconsciously exhibit fewer positive emotions and more negative emotions toward their children, are less responsive and less sensitive to infant cues, less emotionally available, have a less successful maternal role attainment, and have infants that are less securely attached; and in more extreme cases, some women may have thoughts of harming their children (Beck 1995, 1996b; Cohn et al. 1990, 1991; Field et al. 1985; Fowles 1996; Hoffman and Drotar 1991; Jennings et al. 1999; Murray 1991; Murray and Cooper 1996). In other words, most mothers with PPD are suffering some kind of cost, like inadequate social support, and consequently are mothering less.

In this view, mothers with PPD do not have a mental illness, but instead cannot afford to take care of the new infant without more social support, more resources, etc. Treatment should therefore focus on helping mothers get what they need. (See Hagen 1999 and Hagen and Barrett, n.d.)

Prevention

Early identification and intervention improves long term prognoses for most women. Some success with preemptive treatment has been found as well. A major part of prevention is being informed about the risk factors, and the medical community can play a key role in identifying and treating postpartum depression. Women should be screened by their physician to determine their risk for acquiring postpartum depression. Also, proper exercise and nutrition appears to play a role in preventing postpartum, and depressed mood in general.

Additional social support after childbirth has been shown to reduce the risk of postnatal depression for some women.^[29]^[30] The support provided was in person or by phone, offered by professionals or lay people.^[30]

In the US, the American College of Obstetricians and Gynecologists recommends that the first prenatal visit include screening for depression, stress, support, and whether the pregnancy was planned.^[31] However providers do not consistently provide screening and appropriate follow-up.^[31]

Currently, Alberta is the only province in Canada with universal PPD screening which has been in place since 2003. The PPD screening is carried out by Public Health nurses in conjunction with the baby's immunization schedule.

In an examination of data from 10,700 children (born in 2001 and followed until 2007) from the U.S. Early Childhood Longitudinal Study Birth Cohort, it was determined that children of mothers suffering from persistent PPD are more likely to be very short at ages 4 and 5 (at or below the 10th percentile for height at those two ages).^[32] Therefore, infants and young children (especially children not born to short parents) born to mothers with PPD, especially severe and/or long-lasting PPD, might do well to be evaluated more closely, at least for height, during any periodic physical examinations and other health evaluation (well-child) visits.

Nutrition

Pregnant, nursing and postpartum women are strongly encouraged to seek the medical advice of their obstetrician, primary care physician, registered dietitian, or midwife regarding optimal nutrition during pregnancy and after birth.

The following nutritional information may be beneficial in achieving a well-balanced diet during and after pregnancy, but studies are needed to confirm their role in preventing postpartum depression.

Omega-3 fatty acids: Some experts believe that postpartum depression can be attributed to depletion of omega 3 fatty acids from the mother's brain to support development of the brain of the fetus or breast fed infant. This can be prevented by ensuring that sufficient omega 3 fatty acids are provided in the mother's diet.^[33] Good natural sources of omega 3 fatty acids include edible linseed oil, certain fish, grass fed rather than grain fed meat, and eggs from chickens fed on flax seed or other feed high in omega 3 fats. Omega 3 fatty acids can also be purchased in capsule form as a dietary supplement.

Protein can be found in a wide variety of foods. Some examples follow: 3 ounces of most meat products contain 25 grams of protein, 3 large eggs have approximately 19 grams, and 3 ounces of Swiss cheese have about 15 grams.

Hydration: One of the most important roles in any diet (especially for pregnant and nursing mothers) is that of hydration. Physicians may recommend that pregnant women consume ten 8-ounce glasses of water every day. Mothers who are nursing are strongly urged to drink a tall glass of water, milk or juice before sitting down to breastfeed their child. Women should consult with their physicians about caffeine and alcohol consumption postpartum.

Vitamins: A pregnant and postpartum woman should speak with her physician for information about, and a recommendation for, a daily prenatal/postnatal vitamin supplement.

B Vitamins Some limited research has indicated that the intake of B vitamins, specifically riboflavin, can help reduce the chance of post partum depression.^[34] B vitamins are water soluble and must be replenished each day.

Appetite: If a woman finds herself with a loss of appetite or other eating disturbance, she should consult her physician. This may be a sign of postpartum depression and therefore should be discussed with a doctor.^[6]

Treatment

Numerous scientific studies and scholarly journal articles support the notion that postpartum depression is treatable using a variety of methods. If the cause of PPD can be identified, as described above under "social risk factors," treatment should be aimed at mitigating the root cause of the problem, including increased partner support, additional help with childcare, cognitive therapy, etc. Non-professional interventions can be effective.^[35]^[36]

Women need to be taken seriously when symptoms occur. This is a twofold practice: First, the postpartum woman will want to trust her intuition about how she is feeling and believe that her symptoms are real enough to tell her significant other, a close friend, and/or her medical practitioner; erring on the side of caution will go a long way in the treatment of PPD.^[6] Second, the people in whom she confides must take her symptoms seriously as well, aiding her with treatment and support. Partners, friends and physicians may notice changes in a postpartum mother that she may not. Knowing that PPD is treatable with a variety of methods can make persistence in seeking treatment easier.

Various treatment options include:

Medical evaluation to rule out physiological problems
Cognitive behavioral therapy (a form of psychotherapy)
Possible medication
Support groups
Home visits/Home visitors
Healthy diet
Consistent/healthy sleep patterns

An experienced medical professional will work with a postpartum mother to develop a treatment plan that is right for her. This plan may include any combination of the above options, and might include some discussion or feedback from/with a partner. If a woman suffering from PPD does not feel she is being taken seriously or is being recommended a treatment plan she does not feel comfortable with, she will want to seek a second opinion.^[6]

A 1997 study conducted by Appleby et al., confirms that postpartum depressed mothers’ symptoms promptly improved at similar rates when treated with cognitive behavioral therapy or the antidepressant fluoxetine. "A group of 61 depressed mothers completed a 12-week treatment program with or without the antidepressant plus one session versus six sessions of counseling." Improvement followed after "one to four weeks of either treatment."^[37] The findings of Appleby et al.’s study conclusively showed that combining counseling with drug therapy did not add to the improvement of just drug therapy or just counseling.^[37] This suggests that counseling is equally as effective a treatment for PPD as medication, and that "the choice of treatment [psychotherapy vs. medication] may…be made by the women themselves".^[37] Other forms of therapy (like group therapy and home visitors) are also effective treatments for PPD.^[6]

A woman will want to discuss the various treatment options available with her physician and, if considering drug therapy, should speak about which medications are safe to take while breastfeeding.

Treatment for PPD can reduce the length of suffering and its severity. Untreated, the Baby Blues may go away on its own (and does in most cases). PPD may or may not go away without treatment. Speaking to a health care provider as soon as symptoms occur is the safest way to ensure prompt treatment and return to normal life.

According to The National Institutes of Mental Health, studies show that the childbearing years are when a woman is most likely to experience depression in her lifetime. Approximately 15% of all women will experience postpartum depression following the birth of a child. (Chasse, J). When the mental health of the mother is compromised, it affects the entire family. (Postpartum Support International).

Epidemiology

Postpartum depression and illnesses similar to it are found across the globe, with rates of incidence varying from 11% to 42%.^[38]

Society and culture

The Malay culture holds a belief in a spirit known as Hantu Meroyan that resides in the placenta and amniotic fluid. When this spirit is unsatisfied and venting resentment, it causes the mother to experience frequent crying, loss of appetite, and trouble sleeping, known collectively as "sakit meroyan." The mother can be cured with the help of a shaman, who performs a séance to force the spirits to leave.^[39] Some cultures believe that the symptoms of postpartum depression or similar illnesses can be avoided through protective rituals in the period after birth. Chinese women participate in a ritual known as "doing the month" in which they spend the first 30 days after giving birth resting in bed, while the mother or mother-in-law takes care of domestic duties and childcare. In addition, the new mother is not allowed to bathe, wash her hair, leave the house, or be blown by the wind.^[40]

References

^ Paulson, James F. (2010). "Focusing on depression in expectant and new fathers: prenatal and postpartum depression not limited to mothers". Psychiatry Times. 27 (2).
^ Kinnaman, Gary & Jacobs, Richard. Seeing in the Dark. Michigan: Baker Publing Group, 2006.
^ Agency for Health Care Research and Quality: Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes [1].
^ Cox J.L., Holden J.M., Sagovsky R. (1987). "Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale". Br J Psychotherapy. 150: 782–6.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Edinburgh Postnatal Depression Scale
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s The Boston Women's Health Book Collective: Our Bodies Ourselves, pages 489–491, New York: Touchstone Book, 2005
^ Morof, D (2003). "Postnatal depression and sexual health after childbirth". Obstet Gynecol. 102 (6). Elsevier: 1318–25. doi:10.1016/j.obstetgynecol.2003.08.020. PMID 14662221. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ ^a ^b Miller LJ (2002). "Postpartum depression". JAMA. 287 (6): 762–5. doi:10.1001/jama.287.6.762. PMID 11851544. {{cite journal}}: Unknown parameter |month= ignored (help)
^ Postpartum Depression from Pregnancy Guide, by Peter J. Chen, at Hospital of the University of Pennsylvania. Reviewed last on: 10/22/2008
^ Canadian Mental Health Association > Post Partum Depression Retrieved on June 13, 2010
^ ^a ^b Spinelli MG (2009). "Postpartum psychosis: detection of risk and management". Am J Psychiatry. 166 (4): 405–8. doi:10.1176/appi.ajp.2008.08121899. PMID 19339365. {{cite journal}}: Unknown parameter |month= ignored (help)
^ Almeida A, Merminod G, Schechter DS (2009). "Mothers with severe psychiatric illness and their newborns: a hospital-based model of perinatal consultation". Journal of ZERO-TO-THREE: National Center for Infants, Toddlers, and Families. 29 (5): 40–46.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Beard JL, Hendricks MK, Perez EM; et al. (2005). "Maternal iron deficiency anemia affects postpartum emotions and cognition". J. Nutr. 135 (2): 267–72. PMID 15671224. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Soares CN, Zitek B (2008). "Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability?" (PDF). J Psychiatry Neurosci. 33 (4): 331–43. PMC 2440795. PMID 18592034. {{cite journal}}: Unknown parameter |month= ignored (help)
^ Goodman JH (2004). "Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health". J Adv Nurs. 45 (1): 26–35. PMID 14675298. {{cite journal}}: Unknown parameter |month= ignored (help)
^ Block et al. (2000).^{[dead link]}
^ Nielsen Forman D, Videbech P, Hedegaard M, Dalby Salvig J, Secher NJ (2000). "Postpartum depression: identification of women at risk". BJOG. 107 (10): 1210–7. PMID 11028570. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Rich-Edwards JW, Mohllajee AP, Kleinman K; et al. (2008). "Elevated midpregnancy corticotropin-releasing hormone is associated with prenatal, but not postpartum, maternal depression". J. Clin. Endocrinol. Metab. 93 (5): 1946–51. doi:10.1210/jc.2007-2535. PMC 2386278. PMID 18303075. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c ^d McCoy SJ, Beal JM, Shipman SB, Payton ME, Watson GH (2006). "Risk factors for postpartum depression: a retrospective investigation at 4-weeks postnatal and a review of the literature". J Am Osteopath Assoc. 106 (4): 193–8. PMID 16627773. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m Beck CT (1996). "A meta-analysis of the relationship between postpartum depression and infant temperament". Nurs Res. 45 (4): 225–30. PMID 8700656.
^ Stern G, Kruckman L (1983). "Multi-disciplinary perspectives on post-partum depression: an anthropological critique". Soc Sci Med. 17 (15): 1027–41. PMID 6623110.
^ ^a ^b ^c . doi:10.1080/02646830600643908. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
^ Howell EA, Mora P, Leventhal H (2006). "Correlates of early postpartum depressive symptoms". Matern Child Health J. 10 (2): 149–57. doi:10.1007/s10995-005-0048-9. PMC 1592250. PMID 16341910. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Ross LE, Steele L, Goldfinger C, Strike C (2007). "Perinatal depressive symptomatology among lesbian and bisexual women". Arch Womens Ment Health. 10 (2): 53–9. doi:10.1007/s00737-007-0168-x. PMID 17262172.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Ross, Lori E. Perinatal Mental Health in Lesbian Mothers: A Review of Potential Risk and Protective Factors. Women & Health. Vol 41 Issue 3: 113–128
^ ^a ^b ^c E. Hagen (1999). ""The functions of postpartum depression" (PDF)". Evolution and Human Behavior. 20. EHB: 325–359. doi:10.1016/S1090-5138(99)00016-1. Retrieved 2011-12-04. {{cite journal}}: Invalid |display-authors=1 (help); Unknown parameter |author-separator= ignored (help)
^ Kruckman, L. "Rituals as Prevention: The Case of Postpartum Depression," In The Nature and Function of Rituals, Ruth-Inge Heinze, Greenwood Publishing, 1999.
^ Kruckman, L. "A Renewed Call for a Biocultural Understanding of Postpartum Depression Etiology," paper presented at the Max Planck Institute International Symposium, "Postpartum Dysphoria & Depression: Anthropological, Ethnopsychiatric & Evolutionary Dimensions" Reimers Stiftung, Bad Homburg, Germany, 2000.
^ Dennis, CL (2013 Feb 28). "Psychosocial and psychological interventions for preventing postpartum depression". Cochrane database of systematic reviews (Online). 2: CD001134. PMID 23450532. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ ^a ^b PubMed Health. "Preventing postnatal depression". National Center for Biotechnology Information. Retrieved 30 May 2013.
^ ^a ^b "Providers miss opportunities to prevent depression in and discuss birth control with women with unplanned pregnancies". Research Activities (372). Agency for Healthcare Research and Quality: 15. August 2011.
^ http://healthyliving.msn.com/pregnancy-parenting/kids-health/postpartum-depression-may-lead-to-shorter-kids-study-1
^ "Pregnant/Nursing Women Need Proper Fat Intake to Combat Depression". obgyn.net. 2001-10-25. Retrieved 2008-07-04.
^ The Osaka Maternal and Child Health Study
^ http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001134.pub3/abstract
^ http://www.thementalelf.net/mental-health-conditions/depression/psychosocial-and-psychological-interventions-can-prevent-postpartum-depression-says-new-cochrane-review/
^ ^a ^b ^c Appleby, Louis, Rachel Warner, Brian Faragher, and Anna Whitton. "A Controlled Study of Fluoxetine and Cognitive-Behavioural Counseling in the Treatment of Postnatal Depression". British Medical Journal: 932–937. 314.n7085.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Ali, Niloufer S., Badar S. Ali, and Iqbal S. Azam. "Post partum anxiety and depression in peri-urban communities of Karachi, Pakistan: a quasi-experimental study." BMC Public Health. 9:384 (2009). Web
^ McElroy, A., & Townsend, P.K. (2009). ""Culture, Ecology, and Reproduction" in Medical Anthropology in Ecological Perspective."". 5th Boulder: Westview Press. WP. {{cite journal}}: |access-date= requires |url= (help); Invalid |display-authors=1 (help); Unknown parameter |author-separator= ignored (help)CS1 maint: multiple names: authors list (link)
^ Piyanee Klainin & David Gordon Arthur (2009). "Postpartum depression in Asian cultures: A literature review". International Journal of Nursing Studies. 46 (10). IJNS: 1355–1373. doi:10.1016/j.ijnurstu.2009.02.012. PMID 19327773. Retrieved 2011-12-05. {{cite journal}}: Invalid |display-authors=1 (help); Unknown parameter |author-separator= ignored (help)

External links

Postpartum Depression Screening Test - Edinburgh Postnatal Depression Scale
Pandas Foundation Pre And postNatal Depression Advice and Support. A Uk charity supporting individuals and their families
MedlinePlus Overview postnataldepression
"Postpartum depressive illness". GPnotebook.
The functions of postnatal depression
"Depression During and After Pregnancy". Womenshealth.gov. Archived from the original on 24 Oct 2008.
"Depression during and after pregnancy fact sheet". Womenshealth.gov. 6 March 2009.
Mother's Voice UK Charity supporting women and families affected by maternal depression/anxiety/psychosis
Acacia Family Support UK charity supporting women and families affected by post natal depression
Perinatal Pro – expert postpartum depression and perinatal mood disorder information
Postpartum Support International, an exhaustive resource for locating information and postpartum support groups worldwide
Postnatal Depression, information from the mental health charity The Royal College of Psychiatrists
NHS Choices Health A-Z: Postnatal depression
NHS Choices Pregnancy Care Planner: The baby blues and postnatal depression
NHS Choices Live Well: Postnatal depression
PND -PMH Training Training in Postnatal Depression &Perinatal Mental Health Issues.
Postpartum Depression Awareness Resources and Help.
Recovery Is Possible Postnatal Depression help, advice and support for mums, dads, and professionals

[1] Paulson, James F. (2010). "Focusing on depression in expectant and new fathers: prenatal and postpartum depression not limited to mothers". Psychiatry Times. 27 (2).

[2] Kinnaman, Gary & Jacobs, Richard. Seeing in the Dark. Michigan: Baker Publing Group, 2006.

[AHRQ-3] Agency for Health Care Research and Quality: Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes [1].

[4] Cox J.L., Holden J.M., Sagovsky R. (1987). "Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale". Br J Psychotherapy. 150: 782–6.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[5] Edinburgh Postnatal Depression Scale

[OBOS-6] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s The Boston Women's Health Book Collective: Our Bodies Ourselves, pages 489–491, New York: Touchstone Book, 2005

[7] Morof, D (2003). "Postnatal depression and sexual health after childbirth". Obstet Gynecol. 102 (6). Elsevier: 1318–25. doi:10.1016/j.obstetgynecol.2003.08.020. PMID 14662221. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[Miller-2002-8] Miller LJ (2002). "Postpartum depression". JAMA. 287 (6): 762–5. doi:10.1001/jama.287.6.762. PMID 11851544. {{cite journal}}: Unknown parameter |month= ignored (help)

[9] Postpartum Depression from Pregnancy Guide, by Peter J. Chen, at Hospital of the University of Pennsylvania. Reviewed last on: 10/22/2008

[10] Canadian Mental Health Association > Post Partum Depression Retrieved on June 13, 2010

[-200904-11] Spinelli MG (2009). "Postpartum psychosis: detection of risk and management". Am J Psychiatry. 166 (4): 405–8. doi:10.1176/appi.ajp.2008.08121899. PMID 19339365. {{cite journal}}: Unknown parameter |month= ignored (help)

[12] Almeida A, Merminod G, Schechter DS (2009). "Mothers with severe psychiatric illness and their newborns: a hospital-based model of perinatal consultation". Journal of ZERO-TO-THREE: National Center for Infants, Toddlers, and Families. 29 (5): 40–46.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[13] Beard JL, Hendricks MK, Perez EM; et al. (2005). "Maternal iron deficiency anemia affects postpartum emotions and cognition". J. Nutr. 135 (2): 267–72. PMID 15671224. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

[14] Soares CN, Zitek B (2008). "Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability?" (PDF). J Psychiatry Neurosci. 33 (4): 331–43. PMC 2440795. PMID 18592034. {{cite journal}}: Unknown parameter |month= ignored (help)

[-2004-15] Goodman JH (2004). "Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health". J Adv Nurs. 45 (1): 26–35. PMID 14675298. {{cite journal}}: Unknown parameter |month= ignored (help)

[16] Block et al. (2000).^{[dead link]}

[-2000-17] Nielsen Forman D, Videbech P, Hedegaard M, Dalby Salvig J, Secher NJ (2000). "Postpartum depression: identification of women at risk". BJOG. 107 (10): 1210–7. PMID 11028570. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

[pmid18303075-18] Rich-Edwards JW, Mohllajee AP, Kleinman K; et al. (2008). "Elevated midpregnancy corticotropin-releasing hormone is associated with prenatal, but not postpartum, maternal depression". J. Clin. Endocrinol. Metab. 93 (5): 1946–51. doi:10.1210/jc.2007-2535. PMC 2386278. PMID 18303075. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

[McCoy-200604-19] McCoy SJ, Beal JM, Shipman SB, Payton ME, Watson GH (2006). "Risk factors for postpartum depression: a retrospective investigation at 4-weeks postnatal and a review of the literature". J Am Osteopath Assoc. 106 (4): 193–8. PMID 16627773. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

[Beck-200109-20] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m Beck CT (1996). "A meta-analysis of the relationship between postpartum depression and infant temperament". Nurs Res. 45 (4): 225–30. PMID 8700656.

[21] Stern G, Kruckman L (1983). "Multi-disciplinary perspectives on post-partum depression: an anthropological critique". Soc Sci Med. 17 (15): 1027–41. PMID 6623110.

[Segre-22] . doi:10.1080/02646830600643908. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)

[Howell-23] Howell EA, Mora P, Leventhal H (2006). "Correlates of early postpartum depressive symptoms". Matern Child Health J. 10 (2): 149–57. doi:10.1007/s10995-005-0048-9. PMC 1592250. PMID 16341910. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

[Ross-24] Ross LE, Steele L, Goldfinger C, Strike C (2007). "Perinatal depressive symptomatology among lesbian and bisexual women". Arch Womens Ment Health. 10 (2): 53–9. doi:10.1007/s00737-007-0168-x. PMID 17262172.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Ross2-25] Ross, Lori E. Perinatal Mental Health in Lesbian Mothers: A Review of Potential Risk and Protective Factors. Women & Health. Vol 41 Issue 3: 113–128

[Hagan-1999-26] E. Hagen (1999). ""The functions of postpartum depression" (PDF)". Evolution and Human Behavior. 20. EHB: 325–359. doi:10.1016/S1090-5138(99)00016-1. Retrieved 2011-12-04. {{cite journal}}: Invalid |display-authors=1 (help); Unknown parameter |author-separator= ignored (help)

[27] Kruckman, L. "Rituals as Prevention: The Case of Postpartum Depression," In The Nature and Function of Rituals, Ruth-Inge Heinze, Greenwood Publishing, 1999.

[28] Kruckman, L. "A Renewed Call for a Biocultural Understanding of Postpartum Depression Etiology," paper presented at the Max Planck Institute International Symposium, "Postpartum Dysphoria & Depression: Anthropological, Ethnopsychiatric & Evolutionary Dimensions" Reimers Stiftung, Bad Homburg, Germany, 2000.

[29] Dennis, CL (2013 Feb 28). "Psychosocial and psychological interventions for preventing postpartum depression". Cochrane database of systematic reviews (Online). 2: CD001134. PMID 23450532. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

[Pubmed2013-30] PubMed Health. "Preventing postnatal depression". National Center for Biotechnology Information. Retrieved 30 May 2013.

[ahrq2011-31] "Providers miss opportunities to prevent depression in and discuss birth control with women with unplanned pregnancies". Research Activities (372). Agency for Healthcare Research and Quality: 15. August 2011.

[32] ttp://healthyliving.msn.com/pregnancy-parenting/kids-health/postpartum-depression-may-lead-to-shorter-kids-study-1

[fda2004-33] "Pregnant/Nursing Women Need Proper Fat Intake to Combat Depression". obgyn.net. 2001-10-25. Retrieved 2008-07-04.

[34] The Osaka Maternal and Child Health Study

[35] ttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001134.pub3/abstract

[36] ttp://www.thementalelf.net/mental-health-conditions/depression/psychosocial-and-psychological-interventions-can-prevent-postpartum-depression-says-new-cochrane-review/

[Appleby-37] Appleby, Louis, Rachel Warner, Brian Faragher, and Anna Whitton. "A Controlled Study of Fluoxetine and Cognitive-Behavioural Counseling in the Treatment of Postnatal Depression". British Medical Journal: 932–937. 314.n7085.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[38] Ali, Niloufer S., Badar S. Ali, and Iqbal S. Azam. "Post partum anxiety and depression in peri-urban communities of Karachi, Pakistan: a quasi-experimental study." BMC Public Health. 9:384 (2009). Web

[-2009-39] McElroy, A., & Townsend, P.K. (2009). ""Culture, Ecology, and Reproduction" in Medical Anthropology in Ecological Perspective."". 5th Boulder: Westview Press. WP. {{cite journal}}: |access-date= requires |url= (help); Invalid |display-authors=1 (help); Unknown parameter |author-separator= ignored (help)CS1 maint: multiple names: authors list (link)

[-200903-40] Piyanee Klainin & David Gordon Arthur (2009). "Postpartum depression in Asian cultures: A literature review". International Journal of Nursing Studies. 46 (10). IJNS: 1355–1373. doi:10.1016/j.ijnurstu.2009.02.012. PMID 19327773. Retrieved 2011-12-05. {{cite journal}}: Invalid |display-authors=1 (help); Unknown parameter |author-separator= ignored (help)

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@@ Line 36: / Line 36: @@
 === Onset and duration===
-Postpartum depression usually begins in the first few months after childbirth. In [[Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition]] it is defined as depression with onset within 4 weeks after childbirth. Postpartum depression can also affect women who have suffered a miscarriage.<ref name=Miller-2002>{{cite journal
+Postpartum depression usually begins in the first few months after childbirth. In [[Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition]] it is defined as depression with onset within 4 weeks after childbirth. Postpartum depression can also affect women who have suffered a miscarriage.<ref name=Miller-2002>{{cite journal |author=Miller LJ |title=Postpartum depression |journal=JAMA |volume=287 |issue=6 |pages=762–5 |year=2002 |month=February |pmid=11851544 |doi=10.1001/jama.287.6.762}}</ref> It usually begins around two weeks after childbirth.<ref>[http://www.umm.edu/pregnancy/000118.htm Postpartum Depression] from Pregnancy Guide, by Peter J. Chen, at Hospital of the University of Pennsylvania. Reviewed last on: 10/22/2008</ref>
- |publisher=JAMA
- |author= Laura J. Miller
- |year= 2002
-|url=http://jama.ama-assn.org/content/287/6/762.short
- |title= Postpartum Depression
- |accessdate=2011-12-15
-|volume= 287
- |issue=6
- |pages=762–765
- |journal= Journal of American Medical Association
- |author-separator=,
- |display-authors=1}}</ref> It usually begins around two weeks after childbirth.<ref>[http://www.umm.edu/pregnancy/000118.htm Postpartum Depression] from Pregnancy Guide, by Peter J. Chen, at Hospital of the University of Pennsylvania. Reviewed last on: 10/22/2008</ref>
 It may last up to several months or even a year.<ref>[http://www.cmha.ca/bins/content_page.asp?cid=3-86-87-88 Canadian Mental Health Association > Post Partum Depression] Retrieved on June 13, 2010</ref>
 === Psychosis ===
 {{Main|Postpartum psychosis}}
-Postpartum psychosis is a separate mental health disorder which is sometimes erroneously referred to as postpartum depression. It is less common than PPD, and it involves the onset of [[psychotic]] symptoms that may include thought disturbances, delusions, hallucinations and/or disorganized speech or behavior. The prevalence of postpartum psychosis in the general population is 1—2 per 1,000 childbirths, however the rate is 100 times higher in women with bipolar disorder or a previous history of postpartum psychosis. Bipolar disorder and, to a lesser extent, schizophrenia have elevated prevalences in postpartum psychosis.<ref name=-200904>{{cite journal
+Postpartum psychosis is a separate mental health disorder which is sometimes erroneously referred to as postpartum depression. It is less common than PPD, and it involves the onset of [[psychotic]] symptoms that may include thought disturbances, delusions, hallucinations and/or disorganized speech or behavior. The prevalence of postpartum psychosis in the general population is 1—2 per 1,000 childbirths, however the rate is 100 times higher in women with bipolar disorder or a previous history of postpartum psychosis. Bipolar disorder and, to a lesser extent, schizophrenia have elevated prevalences in postpartum psychosis.<ref name=-200904>{{cite journal |author=Spinelli MG |title=Postpartum psychosis: detection of risk and management |journal=Am J Psychiatry |volume=166 |issue=4 |pages=405–8 |year=2009 |month=April |pmid=19339365 |doi=10.1176/appi.ajp.2008.08121899}}</ref>
- |publisher=AJP
- |author= Margaret G. Spinelli
- |year=2009
- |url= http://ajp.psychiatryonline.org/article.aspx?Volume=166&page=405&journalID=13
- |title= Postpartum Psychosis: Detection of Risk and Management
- |accessdate=2011-12-06
- |doi= 10.1176/appi.ajp.2008.08121899
- |volume= 166
- |issue= 4
- |pages= 405–408
- |journal= The American Journal of Psychiatry
- |author-separator=,
- |display-authors=1}}</ref>
 Previous research looked at the relationship between childbirth and postpartum psychosis. Using data on 54,000 births over a 12-year period, researchers found that psychiatric admissions were seven times more likely in the first 30 days after childbirth than in the prepregnancy period and among patients who developed postpartum psychosis after childbirth, 72%—80% had bipolar disorder or schizoaffective disorder and 12% had schizophrenia. Indicators of a possible bipolar diagnosis include a history of missed or misdiagnosed mood episodes, any previous mania or hypomania, and a family history of bipolar disorder or postpartum psychosis.<ref name=-200904/>
@@ Line 86: / Line 61: @@
 ==Causes==
 The [[etiology]] of PPD is not well understood.
-It is sometimes assumed that postpartum depression is caused by a lack of vitamins.<ref>John L. Beard, et al.; J. Nutr. 135: 267–272, 2005.</ref> Other studies tend to show that more likely causes are the significant changes in a woman's hormones during pregnancy.<ref>Soares CN, Zitek B. Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability? J Psychiatry Neurosci. 2008 Jul;33(4):331-43.</ref> Yet other studies have suggested there is no known correlation between hormones and postpartum mood disorders,<ref name=Miller-2002>{{cite journal
+It is sometimes assumed that postpartum depression is caused by a lack of vitamins.<ref>{{cite journal |author=Beard JL, Hendricks MK, Perez EM, ''et al.'' |title=Maternal iron deficiency anemia affects postpartum emotions and cognition |journal=J. Nutr. |volume=135 |issue=2 |pages=267–72 |year=2005 |month=February |pmid=15671224 |url=http://jn.nutrition.org/cgi/pmidlookup?view=long&pmid=15671224}}</ref> Other studies tend to show that more likely causes are the significant changes in a woman's hormones during pregnancy.<ref>{{cite journal |author=Soares CN, Zitek B |title=Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability? |journal=J Psychiatry Neurosci |volume=33 |issue=4 |pages=331–43 |year=2008 |month=July |pmid=18592034 |pmc=2440795 |url=http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-33/issue-4/pdf/pg331.pdf}}</ref> Yet other studies have suggested there is no known correlation between hormones and postpartum mood disorders,<ref name=Miller-2002/> and hormonal treatment has not helped postpartum depression victims.
+Further, fathers, who are not undergoing profound hormonal changes, suffer PPD at relatively high rates.<ref name=-2004>{{cite journal |author=Goodman JH |title=Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health |journal=J Adv Nurs |volume=45 |issue=1 |pages=26–35 |year=2004 |month=January |pmid=14675298}}</ref>
- |publisher=JAMA
+Finally, all mothers experience these hormonal changes, yet only about 10–15% suffer PPD. This does ''not'' mean, however, that hormones do not play a role in PPD.<ref>[http://ajp.psychiatryonline.org/cgi/content/full/157/6/924 Block et al. (2000).]{{dead link}}</ref> For example, ''in women with a history of PPD'', a hormone treatment simulating pregnancy and parturition caused these women to suffer mood symptoms. The same treatment, however, did not cause mood symptoms in women with no history of PPD. One interpretation of these results is that there is a subgroup of women who are vulnerable to hormone changes during pregnancy. Another interpretation is that simulating a pregnancy will trigger PPD in women who are vulnerable to PPD for any of the reasons indicated by Beck's meta-analysis as summarized above.
- |author= Laura J. Miller
- |year= 2002
-|url=http://jama.ama-assn.org/content/287/6/762.short
- |title= Postpartum Depression
- |accessdate=2011-12-15
-|volume= 287
- |issue=6
- |pages=762–765
- |journal= Journal of American Medical Association
- |author-separator=,
- |display-authors=1}}</ref> and hormonal treatment has not helped postpartum depression victims.
-Further, fathers, who are not undergoing profound hormonal changes, suffer PPD at relatively high rates. <ref name=-2004>{{cite journal
- |publisher=JAN
- |author= J.H. Goodman
- |year=2004
- |url=
- |title= "Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health".
- |accessdate=2011-12-06
- |pmid= 14675298
- |volume= 45
- |issue= 1
- |pages= 26–35
- |journal= Journal of Advanced Nursing
- |author-separator=,
- |display-authors=1}}</ref>
-Finally, all mothers experience these hormonal changes, yet only about 10–15% suffer PPD. This does ''not'' mean, however, that hormones do not play a role in PPD.<ref>[http://ajp.psychiatryonline.org/cgi/content/full/157/6/924 Block et al. (2000).]</ref> For example, ''in women with a history of PPD'', a hormone treatment simulating pregnancy and parturition caused these women to suffer mood symptoms. The same treatment, however, did not cause mood symptoms in women with no history of PPD. One interpretation of these results is that there is a subgroup of women who are vulnerable to hormone changes during pregnancy. Another interpretation is that simulating a pregnancy will trigger PPD in women who are vulnerable to PPD for any of the reasons indicated by Beck's meta-analysis as summarized above.
-Profound [[lifestyle (sociology)|lifestyle]] changes brought about by caring for the [[infant]] are also frequently claimed to cause PPD, but, again, there is little evidence for this hypothesis. Mothers who have had several previous children without suffering PPD can nonetheless suffer it with their latest child. <ref name=-2000>{{cite journal
+Profound [[lifestyle (sociology)|lifestyle]] changes brought about by caring for the [[infant]] are also frequently claimed to cause PPD, but, again, there is little evidence for this hypothesis. Mothers who have had several previous children without suffering PPD can nonetheless suffer it with their latest child.<ref name=-2000>{{cite journal |author=Nielsen Forman D, Videbech P, Hedegaard M, Dalby Salvig J, Secher NJ |title=Postpartum depression: identification of women at risk |journal=BJOG |volume=107 |issue=10 |pages=1210–7 |year=2000 |month=October |pmid=11028570}}</ref> Plus, most women experience profound lifestyle changes with their first pregnancy, yet most do not suffer PPD.{{fact}}
- |publisher=BJOG
- |author= Forman D. Nielson, P. Videbech, M. Hedegaard, J. Dalby Slavig, & N.J. Secher
- |year=2000
- |url=
- |title= "Postnatal depression: identification of women at risk".
- |accessdate=2011-12-06
- |pmid= 11028570
- |volume= 107
- |issue= 10
- |pages= 1210–1217
- |journal= British Journal of Obstetrics and Gynaecology
- |author-separator=,
- |display-authors=1}}</ref>
-Plus, most women experience profound lifestyle changes with their first pregnancy, yet most do not suffer PPD.
-In 2009, researchers at the [[University of California, Irvine]], reported that the levels of placental [[corticotropin-releasing hormone]] (CRH) during the 25th week of pregnancy may help predict a woman's chances of developing postpartum depression.<ref name="pmid18303075">{{cite journal |author=Rich-Edwards JW |title=Elevated Midpregnancy Corticotropin-Releasing Hormone Is Associated with Prenatal, But Not Postpartum, Maternal Depression |journal=J. Clin. Endocrinol. Metab. |volume=93 |issue=5 |pages=1946–51 |year=2008 |month=May |pmid=18303075 |doi=10.1210/jc.2007-2535 |url= |pmc=2386278 |author-separator=, |author2=Mohllajee AP |author3=Kleinman K |display-authors=3 |last4=Hacker |first4=M. R. |last5=Majzoub |first5=J. |last6=Wright |first6=R. J. |last7=Gillman |first7=M. W.}}</ref>
+In 2009, researchers at the [[University of California, Irvine]], reported that the levels of placental [[corticotropin-releasing hormone]] (CRH) during the 25th week of pregnancy may help predict a woman's chances of developing postpartum depression.<ref name="pmid18303075">{{cite journal |author=Rich-Edwards JW, Mohllajee AP, Kleinman K, ''et al.'' |title=Elevated midpregnancy corticotropin-releasing hormone is associated with prenatal, but not postpartum, maternal depression |journal=J. Clin. Endocrinol. Metab. |volume=93 |issue=5 |pages=1946–51 |year=2008 |month=May |pmid=18303075 |pmc=2386278 |doi=10.1210/jc.2007-2535}}</ref>
 === Risk factors ===
@@ Line 138: / Line 74: @@
 *[[Childbirth-related posttraumatic stress disorder|Birth-related psychological trauma]]
 *[[Birth trauma (physical)|Birth-related physiological trauma]]
-*Formula feeding rather than [[breast-feeding]] <ref name=McCoy-200604>{{cite journal
+*Formula feeding rather than [[breast-feeding]]<ref name=McCoy-200604>{{cite journal |author=McCoy SJ, Beal JM, Shipman SB, Payton ME, Watson GH |title=Risk factors for postpartum depression: a retrospective investigation at 4-weeks postnatal and a review of the literature |journal=J Am Osteopath Assoc |volume=106 |issue=4 |pages=193–8 |year=2006 |month=April |pmid=16627773}}</ref>
+*A history of depression<ref name=McCoy-200604 />
- |publisher=JAOA
+*Cigarette smoking<ref name=McCoy-200604 />
- |author=Sarah J. Breese McCoy
+*Low self esteem<ref name=Beck-200109>{{cite journal |author=Beck CT |title=A meta-analysis of the relationship between postpartum depression and infant temperament |journal=Nurs Res |volume=45 |issue=4 |pages=225–30 |year=1996 |pmid=8700656}}</ref>
- |date=April 2006
+*Childcare stress<ref name=Beck-200109 />
- |url=http://www.jaoa.org/cgi/content/full/106/4/193
+*Prenatal depression during pregnancy<ref name=Beck-200109 />
- |title=Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature
+*Prenatal anxiety<ref name=Beck-200109 />
- |accessdate=2008-07-04
+*Low social support<ref name=Beck-200109 />
- |pmid=16627773
+*Life stress<ref name=Beck-200109 />
- |volume=106
+*Poor marital relationship<ref name=Beck-200109 />
- |issue=4
+*Infant temperament problems/[[Baby colic|colic]]<ref name=Beck-200109 />
- |pages=193–8
+*[[Maternity blues]]<ref name=Beck-200109 />
- |journal=The Journal of the American Osteopathic Association
+*Single Marital Status<ref name=Beck-200109 />
- |author-separator=,
+*Low socioeconomic status<ref name=Beck-200109 />
- |display-authors=1}}</ref>
-*A history of depression <ref name=McCoy-200604 />
+*[[Unintended pregnancy|Unplanned/unwanted pregnancy]]<ref name=Beck-200109 />
-*Cigarette smoking <ref name=McCoy-200604 />
-*Low self esteem <ref name=Beck-200109>{{cite journal
- |publisher=NR
- |author=Cheryl T. Beck
- |date=April 2001
- |url= http://www.ncbi.nlm.nih.gov/pubmed/8700656
- |title= Predictors of Postnatal Depression: An Update
- |accessdate=2010-11-04
- |pmid=11570712
- |volume=50
- |issue=5
- |pages=275–285
- |journal=Nursing Research
- |author-separator=,
- |display-authors=1}}</ref>
-*Childcare stress <ref name=Beck-200109 />
-*Prenatal depression during pregnancy <ref name=Beck-200109 />
-*Prenatal anxiety <ref name=Beck-200109 />
-*Low social support <ref name=Beck-200109 />
-*Life stress <ref name=Beck-200109 />
-*Poor marital relationship <ref name=Beck-200109 />
-*Infant temperament problems/[[Baby colic|colic]] <ref name=Beck-200109 />
-*[[Maternity blues]] <ref name=Beck-200109 />
-*Single Marital Status <ref name=Beck-200109 />
-*Low socioeconomic status <ref name=Beck-200109 />
-*[[Unintended pregnancy|Unplanned/unwanted pregnancy]] <ref name=Beck-200109 />
 Of these, formula feeding, a history of depression, and cigarette smoking have been shown to be additive effects.<ref name=McCoy-200604 />
-These factors are known to [[correlation|correlate]] with PPD. "Correlation" in this case means that, for example, high levels of prenatal depression are associated with high levels of postnatal depression, and low levels of prenatal depression are associated with low levels of postnatal depression. But this does not mean the prenatal depression causes postnatal depression—they might both be caused by some third factor. In contrast, some factors, such as lack of social support, almost certainly ''cause'' postpartum depression. (The ''causal'' role of lack of social support in PPD is strongly suggested by several studies, including O'Hara 1985, Field et al. 1985; and Gotlib et al. 1991.) Anthropologists Kruckman and Stern tested the idea cross culturally, and their pioneering study determined six ways in which postpartum rituals, including the use of the postpartum ritual, la cuarentena, in Chicago Latina mothers, to protect or cushion the expression of mood disorders.<ref>Stern, G., Kruckman, L. "Multi-Disciplinary Perspectives on Postpartum Depression: An Anthropological Critique," Social Science and Medicine, Vol. 17, 15, pages 1027-1041, 1983.</ref>
+These factors are known to [[correlation|correlate]] with PPD. "Correlation" in this case means that, for example, high levels of prenatal depression are associated with high levels of postnatal depression, and low levels of prenatal depression are associated with low levels of postnatal depression. But this does not mean the prenatal depression causes postnatal depression—they might both be caused by some third factor. In contrast, some factors, such as lack of social support, almost certainly ''cause'' postpartum depression. (The ''causal'' role of lack of social support in PPD is strongly suggested by several studies, including O'Hara 1985, Field et al. 1985; and Gotlib et al. 1991.) Anthropologists Kruckman and Stern tested the idea cross culturally, and their pioneering study determined six ways in which postpartum rituals, including the use of the postpartum ritual, la cuarentena, in Chicago Latina mothers, to protect or cushion the expression of mood disorders.<ref>{{cite journal |author=Stern G, Kruckman L |title=Multi-disciplinary perspectives on post-partum depression: an anthropological critique |journal=Soc Sci Med |volume=17 |issue=15 |pages=1027–41 |year=1983 |pmid=6623110}}</ref>
-In addition to Beck’s meta-analysis cited above, other academic studies have shown a correlation between a mother’s [[Race (classification of human beings)|race]], [[social class]] and/or [[sexual orientation]] and postpartum depression. In 2006 Segre et al., conducted a study "on the extent to which [[Race (classification of human beings)|race]]/ethnicity is a risk factor" for PPD.<ref name="Segre">Segre, Lisa S, Mary E. Losch, Michael W. O’Hara. Race/Ethnicity and Perinatal Depressed Mood. Journal of Reproductive and Infant Psychology. Vol 24 No 2: 99–106</ref> Studying 26,877 postpartum women they found that 15.7% were depressed. Of the women who suffered from PPD, African American women suffered at a rate of 25.2%, American Indian/Native Alaskan women at 22.9%, Caucasian women at 15.5%, Hispanic women at 15.3%, and 11.5% for those reporting Asian/Pacific Islander. Even when "important social factors such as age, income, education, marital status, and baby’s health were controlled, African American women still emerged with significantly increased risk for…PPD".<ref name="Segre"/>
+In addition to Beck’s meta-analysis cited above, other academic studies have shown a correlation between a mother’s [[Race (classification of human beings)|race]], [[social class]] and/or [[sexual orientation]] and postpartum depression. In 2006 Segre et al., conducted a study "on the extent to which [[Race (classification of human beings)|race]]/ethnicity is a risk factor" for PPD.<ref name="Segre">{{cite journal |doi=10.1080/02646830600643908}}</ref> Studying 26,877 postpartum women they found that 15.7% were depressed. Of the women who suffered from PPD, African American women suffered at a rate of 25.2%, American Indian/Native Alaskan women at 22.9%, Caucasian women at 15.5%, Hispanic women at 15.3%, and 11.5% for those reporting Asian/Pacific Islander. Even when "important social factors such as age, income, education, marital status, and baby’s health were controlled, African American women still emerged with significantly increased risk for…PPD".<ref name="Segre"/>
 Segre et al., also found a correlation between a mother’s [[social class]] and PPD. Not surprisingly, women with fewer resources indicate a higher level of postpartum depression and stress than those with more financial resources. Rates of PPD decreased as income increased as follows:<ref name="Segre"/>  Women with fewer resources are also more likely to have an unintended or unwanted pregnancy, further increasing risk of PPD. Beck (2001) concurs with this, stating that these women are at risk for PPD because they may experience stressors such as financial difficulties. Single mothers of low income may have fewer resources that they have access to while transitioning into motherhood.
@@ Line 212: / Line 122: @@
 |}
-Likewise, a study conducted by Howell et al. in 2006 confirms Segre’s findings that women who are not Caucasian and in lower socioeconomic categories have more symptoms of PPD.<ref name="Howell">Howell, Elizabeth A, Pablo Mora, Howard Leventhal. Correlates of Early Postpartum Depressive Symptoms. Maternal and Child Health Journal. Vol 10 No 2: 149–157</ref>
+Likewise, a study conducted by Howell et al. in 2006 confirms Segre’s findings that women who are not Caucasian and in lower socioeconomic categories have more symptoms of PPD.<ref name="Howell">{{cite journal |author=Howell EA, Mora P, Leventhal H |title=Correlates of early postpartum depressive symptoms |journal=Matern Child Health J |volume=10 |issue=2 |pages=149–57 |year=2006 |month=March |pmid=16341910 |pmc=1592250 |doi=10.1007/s10995-005-0048-9}}</ref>
-In a 2007 study conducted by Ross et al., lesbian and bisexual mothers were tested for PPD and then compared with a heterosexual sample. Ross et al. found that "lesbian and bisexual biological mothers had significantly higher Edinburgh Postnatal Depression Scale (EPDS) scores than the…sample of heterosexual women."<ref name="Ross">Ross, Lori E, L Steele, C Goldfinger, and C Strike. Perinatal Depressive Symptomatology Among Lesbian and Bisexual Women. Archives of Women’s Mental Health. Vol 10 No 2: 53–59</ref> The Ross study suggests that PPD may be more common among lesbian and bisexual mothers. From a study conducted in 2005 by Ross, the higher rates of PPD in lesbian/bisexual mothers than heterosexual mothers may be due to less "social support, particularly from their families of origin and…additional stress due to homophobic discrimination" in society.<ref name="Ross2">Ross, Lori E. Perinatal Mental Health in Lesbian Mothers: A Review of Potential Risk and Protective Factors. [[Women & Health]]. Vol 41 Issue 3: 113–128</ref>
+In a 2007 study conducted by Ross et al., lesbian and bisexual mothers were tested for PPD and then compared with a heterosexual sample. Ross et al. found that "lesbian and bisexual biological mothers had significantly higher Edinburgh Postnatal Depression Scale (EPDS) scores than the…sample of heterosexual women."<ref name="Ross">{{cite journal |author=Ross LE, Steele L, Goldfinger C, Strike C |title=Perinatal depressive symptomatology among lesbian and bisexual women |journal=Arch Womens Ment Health |volume=10 |issue=2 |pages=53–9 |year=2007 |pmid=17262172 |doi=10.1007/s00737-007-0168-x}}</ref> The Ross study suggests that PPD may be more common among lesbian and bisexual mothers. From a study conducted in 2005 by Ross, the higher rates of PPD in lesbian/bisexual mothers than heterosexual mothers may be due to less "social support, particularly from their families of origin and…additional stress due to homophobic discrimination" in society.<ref name="Ross2">Ross, Lori E. Perinatal Mental Health in Lesbian Mothers: A Review of Potential Risk and Protective Factors. [[Women & Health]]. Vol 41 Issue 3: 113–128</ref>
 ===Evolutionary psychological===