Postpartum Depression May Not Start After Birth

Source: Vale Marquez / Pexels

While we commonly think of postpartum depression when we think about maternal mental health, there is much more to the story. A seminal study of 10,000 mothers who recently gave birth offers a more complicated, but useful, picture of maternal mental health. Researchers found that among women who screened positive for depression in the postpartum period and then completed a comprehensive diagnostic assessment, their mental health experiences varied considerably. Some women's current psychiatric episodes began after birth, while others began during pregnancy or even before.

In other words, women experiencing postpartum mental health difficulties do not all have the same diagnosis, symptom presentation, or symptom onset. Understanding these differences gives us a more complete picture of maternal mental health.

Onset of Mental Health Symptoms

One of the study's most interesting findings was the diverse onset of symptoms:

• 40.1 percent in postpartum
• 33.4 percent during pregnancy
• 26.5 percent before pregnancy

These findings describe when a woman's current psychiatric episode began, not necessarily when they first experienced the condition. For many women who experience significant mental health symptoms after giving birth, the difficulties actually began earlier. In fact, for nearly 60 percent of the women, the current psychiatric episode identified postpartum actually began before or during pregnancy. Among the women diagnosed with postpartum depression, the majority (65 percent) had recurrent depression, rather than a new onset. However, by the time a mother seeks help postpartum, all of these experiences may simply be described as “postpartum depression.”

Source: Helena Lopes / Pexels

Depression Isn't the Whole Story

The researchers also found that a positive screen on a commonly used perinatal depression screening tool (i.e., the Edinburgh Postnatal Depression Scale, EDPS) did not necessarily mean a woman had depression. Instead, among the women who completed an extensive follow-up psychiatric interview, the primary diagnoses were:

• 68.5 percent with depression
• 22.6 percent with bipolar disorder
• 5.6 percent with anxiety disorder

Importantly, the researchers found that among women with a primary diagnosis of depression, 66 percent also had at least one additional diagnosis, most commonly an anxiety disorder. Another important finding was that 22.6 percent of the women with a positive screen for depression were determined to have bipolar disorder through the diagnostic assessment. In other words, nearly one in four women flagged with "postpartum depression" actually had bipolar disorder. This can occur because depressive symptoms are a part of bipolar disorder. As such, a person may primarily experience depression, and they (and their provider) may not recognize periods of (hypo)mania indicative of bipolar disorder. This is significant because treatment geared toward bipolar disorder would be indicated rather than standard depression treatments.

Source: Sarah Chai / Pexels

Lastly, thoughts of self-harm in this population are not rare. Among the women screened, 3.2 percent reported some degree of self-harm ideation, with higher rates (19.3 percent) among women who screened positive for depression.

The perinatal period is a vulnerable time for new onset and recurrence of psychiatric illness, with as many as one in five women experiencing a perinatal mood and anxiety disorder. The findings of this study highlight that there is no single timeline or experience that defines perinatal mental health. As such, follow-up clinical assessment and discussions are required because symptoms can overlap. Feeling sad, overwhelmed, unable to enjoy things, or unable to sleep can occur in perinatal depression as well as other mental health conditions. Proper diagnosis can help guide appropriate treatment and support.

Facebook image: Drazen Zigic/Shutterstock