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Postpartum Depression: Who is at Risk?

By Ilyene Barsky, LCSW

Fact: Approximately 20 percent of all new mothers will experience some form of postpartum depression.
Fact: No woman can consider herself immune.

Given the above facts, can we accurately predict which women will experience postpartum depression (PPD)? Although PPD is no respector of persons, some women do appear to run a significantly higher risk than others. Experts have noted a number of factors which indicate a higher than-average risk. In doing so, they look at both biological and psychosocial determinants.

      1. The single greatest predictor of postpartum depression is a previous episode of postpartum depression. During her 30 years of postpartum research in England, Dr. Katharina Dalton, MD found a 66% recurrence rate for women who had not sought treatment. The recurrence is generally of the same type (mild, moderate, or severe). The odds of a postpartum psychosis (PPS) has been estimated to be one to three in 1,000. If a woman experienced PPS after a delivery, the chance of recurrence jumps to 33 percent.

      2. In general, women with a history of psychiatric disorders, have a higher probability of repeating the psychiatric disorder which was present during the first year postpartum. (i.e.: anxiety, obsessive compulsive behavior, etc.) However, the vast majority of PPD sufferers have no history of psychiatric illness.

      3. Women with a history of hormonal problems prior to childbirth, are also in a high risk category. This group includes women with PMS problems and thyroid disorders. The conditions are exacerbated by childbirth and the subsequent hormonal imbalance. A woman who has had no problems with PMS may discover that a case of PPD, without her realizing it, slowly develops into a characteristic PMS. The symptoms are that similar. In addition, these same women will probably have menopausal problems as well. It is also interesting to note that women who give birth to female babies have a higher incidence of thyroid problems during the postpartum period. Symptoms of hypothyroidism (also know as "combat fatigue") and PPD are remarkably similar. In fact, one can mask the other.

      4. Another high risk factor is a family history of PPD (i.e.: mother, grandmother, or sister) or a dysfunctional family of origin. Women who grew up in a dysfunctional family and have not worked through their own childhood issues are at risk of PPD when they have their own children.
      The birth of a baby tends to rekindle past crises. Parents or siblings with mood illness (not related to childbirth) also put the new mother at risk as does separation from a parent during childhood (either through death or divorce). If the new mother's mother is deceased, she is especially susceptible to PPD.

      5. There are also certain personality structures that are vulnerable to PPD. The perfectionist woman with unrealistic expectations and anticipations is at risk. Ditto the "co-dependent" who only wants to please others. These personality "types" are hesitant to discuss their negative feelings (which only worsens the condition).

      6. The bearer of an unwanted pregnancy; a long, difficult or complicated labor; an unsupported labor; a birth experience that didn't fulfill expectations; or delivery of a premature, compromised, or defective baby is also an increased risk of PPD.

       7. Older women, career women, women who have had abortions, miscarriages, or infertility problems are also viewed as high risk candidates. After all, they waited or went through a great deal of trouble to have a baby. The older woman may be set in her ways and her peers probably have grown children. It's difficult to adjust. The same is true of the career woman - especially if she's been "successful."

      8. One of the highest predictors or risk for postpartum illness is the stability of the couple's relationship. Issues such as denial (of a previous PPD), being non-supportive or unavailable in some way, only increase the likelihood of PPD.
      Good prenatal care, good preparation for childbirth, support during birthing, household help during the postpartum period, and strong emotional support are necessary ingredients in order to avoid or minimize PPD.

Any expectant woman who is aware or having several of the factors mentioned here should consider herself at risk. There are a number of viable treatment alternatives available before, during, and after the pregnancy. They include counseling and/or pharmacological treatment. However, none of them work unless the depressive or potential PPD candidate is identified.