Understanding postpartum depression critical to improving care for mothers and infants

Physicians should screen mothers for postpartum depression regularly for at least a year following childbirth to better identify women who develop symptoms throughout the year and those whose depression persists, University of Rochester Medical Center researchers say.

"If you only screen early or if you only screen once, you will miss some," said Linda Chaudron, M.D., an assistant professor of psychiatry, pediatrics and obstetrics and gynecology at the Medical Center who is leading a series of studies focusing on postpartum depression.

In a recent analysis of records from a pediatric clinic that uses a common postpartum questionnaire to screen mothers, Chaudron and the research group found that of women who scored high on a depression screening scale sometime in the postpartum year, 26 percent did not develop high symptom levels of postpartum depression until after three months and that 33 percent had high levels throughout the year. The results of the study are published in the July/August issue of the journal Ambulatory Pediatrics.

"I was surprised at the high percentage of women who continued to be depressed throughout the year," Chaudron said.

Earlier this year, New Jersey Governor Jon S. Corzine signed legislation requiring health care professionals providing postnatal care to screen new mothers for postpartum depression, and requiring health care professionals to educate women and their families about the disorder. Health care providers in several other states have adopted similar screening programs.

"With the increased attention to screening, we ought to have a better idea about when to screen," Chaudron said. "There are a lot more women we need to be thinking about, identifying and helping get treatment."

Pediatricians and other physicians who refer mothers for treatment of depression also can help track how mothers are doing, even if they are in treatment.

"They should find out how the mother is doing and whether she is receiving the proper treatment," Chaudron said.

The study reported in Ambulatory Pediatrics was limited. The records covered only 49 mothers. But Chaudron said the report highlighted that women can develop new symptoms later in the year and can continue to have symptoms for many months.

According to the American Psychiatric Association, symptoms of postpartum depression include sadness, sluggishness, fatigue, feelings of hopelessness, disturbances of sleep or appetite, lack of interest in the baby, uncontrollable crying, mood swings and fear of harming the baby. Many mothers also report significant anxiety. Postpartum depression is different from "baby blues," a mild, short-lived depression that many women experience in the first few days or weeks following childbirth. Postpartum depression affects one in eight women and lasts more than two weeks. It can interfere with daily living for a longer period of time.

Medication and talk therapy are effective treatments for postpartum depression. "Support groups also can decrease the isolation and stigma that depressed mothers can feel," Chaudron said.

Understanding postpartum depression is critical to improving care for mothers and infants. Chaudron and her colleagues currently are conducting a variety of studies, including looking at the course of postpartum depression, exploring the relationship between postpartum depression and anxiety, and investigating the use of an antidepressant for the treatment of postpartum depression. Anyone interested in finding out more about the treatment study, should call 585-275-9583.