Depression: Who is at Risk?
Ilyene Barsky, LCSW
Approximately 20 percent of all new mothers will experience some
form of postpartum depression.
Fact: No woman can consider herself immune.
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
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.
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.
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.
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
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
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 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.
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."
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.
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