Perinatal mental illness: Definition, description and aetiology
Open accessAbstract
Perinatal mental illness is a significant complication of pregnancy and the postpartum period. These disorders include depression, anxiety disorders, and postpartum psychosis, which usually manifests as bipolar disorder. Perinatal depression and anxiety are common, with prevalence rates for major and minor depression up to almost 20% during pregnancy and the first 3 months postpartum. Postpartum blues are a common but lesser manifestation of postpartum affective disturbance. Perinatal psychiatric disorders impair a woman's function and are associated with suboptimal development of her offspring. Risk factors include past history of depression, anxiety, or bipolar disorder, as well psychosocial factors, such as ongoing conflict with the partner, poor social support, and ongoing stressful life events. Early symptoms of depression, anxiety, and mania can be detected through screening in pregnancy and the postpartum period. Early detection and effective management of perinatal psychiatric disorders are critical for the welfare of women and their offspring.
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- Premisecitation
Postpartum blues are a frequent but milder form of postpartum affective disturbance.
“Postpartum blues are a common but lesser manifestation of postpartum affective disturbance.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Premisecitation
Prevalence estimates for perinatal depressive disorders vary widely depending on how the disorder is defined and the time period used.
“Prevalence estimates for perinatal depressive disorders vary considerably depending upon the definition of the disorder and the period over which prevalence is determined [9,10].”
Quote in the paperNot a substantial claim0 of 2 sources checked - Premisecitation
Depression and anxiety in the perinatal period are frequent; combined major and minor depression can affect nearly one in five women during pregnancy and the initial three months after birth.
“Perinatal depression and anxiety are common, with prevalence rates for major and minor depression up to almost 20% during pregnancy and the first 3 months postpartum.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source
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- Premisereasoning
A history of anxiety disorders is the main risk factor for perinatal anxiety disorders.
“As with perinatal depression, the major risk factor for perinatal anxiety disorders is a history of anxiety disorders.”
Quote in the paperNot a substantial claim - Premisecitation
In a US study, only 1.9% of pregnant women met criteria for generalised anxiety disorder.
“In a US study, however, only 1.9% of pregnant women met criteria for GAD [18].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] Mota, 2008, The relationship between mental disorders, quality of life, and pregnancy: findings from a nationally representative sample, J Affect Disord source
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- Premisecitation
In a large postpartum screening study with diagnostic follow-up, 66% of women with major postpartum depression had comorbid anxiety disorders.
“In a large-scale postpartum screening study with follow-up diagnostic evaluations [20], 66% of women with major depression in the postpartum period had comorbid anxiety disorders.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Wisner, 2013, Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings, JAMA Psychiatry source
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- Premisecitation
Women are more vulnerable to affective psychoses after childbirth than at any other time in their lives.
“Women are vulnerable to affective psychoses after birth more than at any other time during their lives [28].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] Munk-Olsen, 2009, Risks and predictors of readmission for a mental disorder during the postpartum period, Arch Gen Psychiatry source
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- Interpretationreasoning
The reviewed literature consistently indicates that depression is common during pregnancy and after childbirth in both developing and developed countries.
“All of these reviews and empirical studies conclude that depression is common during pregnancy and after delivery in developing and developed countries.”
Quote in the paperNot a substantial claim - Premisecitation
Recognising and clinically diagnosing bipolar disorder is the most important prerequisite for adequate treatment.
“The recognition and clinical diagnosis of bipolar disorder is by far the most important prerequisite for adequate treatment [40].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40] Arvilommi, 2007, Adequacy of treatment received by diagnosed and undiagnosed patients with bipolar I and II disorders, J Clin Psychiatry source
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- Premisecitation
Women with bipolar disorder are especially prone to psychotic and non-psychotic episodes in the postpartum period.
“Women with bipolar disorder are particularly vulnerable to developing psychotic and non-psychotic episodes in the postpartum period [29,30].”
Quote in the paperNot a substantial claim0 of 2 sources checked - Interpretationreasoning
Anxiety symptoms, from excessive worry to panic attacks, are common during pregnancy and the postpartum period.
“What these prevalence rates suggest is that anxiety ranging from excessive worry to panic attacks is prevalent during pregnancy and the postpartum period.”
Quote in the paperSubstantial claim - Premisenone given
A broad range of anxiety disorders occur in the perinatal period, including generalised anxiety, obsessive-compulsive, panic, and social anxiety disorders.
“A wide range of anxiety disorders are prevalent in the perinatal period. These include generalised anxiety, obsessive–compulsive, panic, and social anxiety disorders.”
Quote in the paperNot a substantial claim - Premisecitation
Sleep deprivation and disrupted circadian rhythms during late pregnancy, labour, and frequent newborn feeding promote mood destabilization.
“Sleep deprivation and interference with circadian rhythms during late pregnancy, labour, and frequent newborn feeding promote mood destabilization [27].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] Yonkers, 2004, Management of bipolar disorder during pregnancy and the postpartum period, Am J Psychiatry source
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- Premisecitation
Half of women with 'treatment resistant' postpartum depression actually have undiagnosed bipolar disorder.
“Half of women who have ‘treatment resistant’ postpartum depression actually suffer from undiagnosed bipolar disorder [42].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] Sharma, 2009, Bipolar II postpartum depression: detection, diagnosis, and treatment, Am J Psychiatry source
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- Premisereasoning
The effect of pregnancy on the course of bipolar disorder remains unclear.
“The effect of pregnancy on the course of bipolar disorder has not been elucidated.”
Quote in the paperNot a substantial claim - Premisecitation
Symptom patterns in postpartum psychosis consistently differ from those in psychosis unrelated to childbearing.
“The symptom patterns in women with postpartum psychosis have consistently been reported to differ from women with psychosis not related to childbearing [22–24].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [22] Brockington, 1981, Puerperal psychosis. Phenomena and diagnosis, Arch Gen Psychiatry source
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- cites [23] Kadrmas, 1979, Postpartum mania, Br J Psychiatry source
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- cites [24] Platz, 1988, A matched-control follow-up and family study of ‘puerperal psychoses’, Br J Psychiatry source
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- Premisecitation
During the first six months after delivery, generalised anxiety disorder rates ranged from 6.1% to 7.7%.
“In the first 6 months after delivery, rates of GAD, based on several studies, ranged from 6.1% to 7.7%.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Wenzel, 2011
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- Premisecitation
Failure to recognise underlying bipolarity means few women with bipolar disorder receive appropriate treatment.
“Although many women with bipolar disorder receive treatment for depression or comorbid mental disorders (such as substance abuse or anxiety disorders), lack of recognition of the underlying bipolarity results in few receiving appropriate treatment [41].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41] Merikangas, 2007, Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication, Arch Gen Psychiatry source
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- Premisecitation
Prevalence estimates for postpartum blues range from 26% to 84%, depending on how stringent the criteria are.
“Prevalence estimates for the blues range from 26% [46] to 84% [47], reflecting more or less stringent criteria.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Premisecitation
In the only published screening study for postpartum bipolar disorder, the Mood Disorders Questionnaire had a sensitivity of 75% and specificity of 87% using the original scoring criteria.
“In the only published screening study for postpartum BD, Sharma and Xie [39] gave women with a diagnosis of MDD (n = 68) or bipolar disorder (n = 57) the MDQ at 2–4 weeks after delivery. The MDQ yielded a sensitivity of 75% and specificity of 87% with the original scoring criteria.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [39] Sharma, 2011, Screening for postpartum bipolar disorder: validation of the Mood Disorder Questionnaire, J Affect Disord source
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- Premisecitation
A separate meta-analysis of 21 studies and 19,284 participants reported depression prevalence in pregnancy of 7.4% in the first trimester, 12.8% in the second, and 12.0% in the third.
“At about the same time, Bennett et al. [11] conducted a separate meta-analysis of depression in pregnancy based on 21 studies and 19,284 participants, and reported prevalence rates of 7.4% (first trimester), 12.8% (second trimester), and 12.0% (third trimester).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] Bennett, 2004, Prevalence of depression during pregnancy: systematic review, Obstet Gynecol source
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- Interpretationreasoning
The presence of two distinct mood factors, negative and positive affect, in the early postpartum period suggests that mood structure at this time is the same as at other times in a woman's life.
“The findings that two distinct mood factors exist — negative and positive affect — in the early postpartum period suggest that the structure of mood in the postpartum period is the same as the structure of mood at other times in a woman’s life.”
Quote in the paperSubstantial claim - Premisecitation
Good evidence indicates that mood symptoms worsen in the first week postpartum and then gradually improve.
“Good evidence shows that mood symptoms worsen in the first week postpartum and then gradually improve [50].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [50] O'Hara, 1995
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- Premisecitation
Women who develop postpartum psychosis usually receive a diagnosis consistent with bipolar depression, mania, or mixed state with psychotic features.
“Mothers who develop postpartum psychosis usually have a diagnosis consistent with bipolar depression, mania, or mixed state, with psychotic features [27].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] Yonkers, 2004, Management of bipolar disorder during pregnancy and the postpartum period, Am J Psychiatry source
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- Premisecitation
Reported rates of anxiety disorders during pregnancy and postpartum vary widely.
“Rates of anxiety disorders in pregnancy and the postpartum period range widely.”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [17] Adewuya, 2006, Anxiety disorders among Nigerian women in late pregnancy: a controlled study, Arch Womens Ment Health source
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- cites [18] Mota, 2008, The relationship between mental disorders, quality of life, and pregnancy: findings from a nationally representative sample, J Affect Disord source
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- cites [19] Wenzel, 2011
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- Premisecitation
In a Nigerian study, 10.5% of pregnant women met DSM-IV criteria for generalised anxiety disorder.
“For example, in a Nigerian study, Adewuya et al. [17] reported that 10.5% of pregnant women met DSM-IV criteria for generalised anxiety disorder (GAD).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] Adewuya, 2006, Anxiety disorders among Nigerian women in late pregnancy: a controlled study, Arch Womens Ment Health source
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- Premisecitation
Women with OCD but without psychosis or severe personality disorder are not at increased risk of aggressive harm to their infants.
“Women with OCD without psychosis or severe personality disorder have no increased risk of aggressive harm to their infants [21,43,45].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [21] Sit, 2006, A review of postpartum psychosis, J Womens Health (Larchmt) source
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- cites [43] Hudak, 2012, Diagnosis and treatment of postpartum obsessions and compulsions that involve infant harm, Am J Psychiatry source
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- cites [45] Abramowitz, 2003, Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature, J Anxiety Disord source
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- Study design and conductreasoning
Both studies have significant limitations because they were not designed specifically to compare the prevalence of perinatal depression with depression at other times in a woman's life.
“Both studies have significant limitations because they were not designed specifically to determine the prevalence of perinatal depression relative to depression that occurs at other times in a woman’s life.”
Quote in the paperSubstantial claim - Premisereasoning
This time frame overlaps with the baby blues and early postpartum depression.
“This time frame overlaps with the baby blues and early postpartum depression.”
Quote in the paperNot a substantial claim - Premisecitation
Genetic studies have identified specific hereditary factors in postpartum depression.
“Genetic studies have also pointed to specific hereditary factors in postpartum depression [32].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32] Mahon, 2009, Genome-wide linkage and follow-up association study of postpartum mood symptoms, Am J Psychiatry source
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- Premisecitation
Women who develop postpartum onset major depression are differentially sensitive to the mood-destabilising effects of reproductive hormone withdrawal at birth.
“Women who develop postpartum onset major depression are differentially sensitive to the mood-destabilising effects of withdrawal from reproductive hormones at birth.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] Bloch, 2000, Effects of gonadal steroids in women with a history of postpartum depression, Am J Psychiatry source
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- Premisenone given
Positive social relationships often buffer the effects of psychiatric vulnerability and life stress.
“Positive social relationships are often instrumental in buffering the effects of psychiatric vulnerability and life stress.”
Quote in the paperSubstantial claim - Premisecitation
In a large US sample of postpartum and non-postpartum women, after adjusting for sociodemographic characteristics, prior depression, overall health, and stressful life events, the odds ratio for postpartum depression was 1.52 (CI 1.07-2.15), a significant effect.
“For example, Vesga-Lopez et al. [54] found that, in a large sample of postpartum and non-postpartum women (in the USA) after controlling for sociodemographic characteristics, previous history of depression, overall health and stressful life events, the odds ratio for depression in the postpartum was 1.52 (CI 1.07 to 2.15), a significant effect.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [54] Vesga-Lopez, 2008, Psychiatric disorders in pregnant and postpartum women in the United States, Arch Gen Psychiatry source
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- Premisecitation
Genome-wide data suggest that genetic variations on specific chromosomes may increase susceptibility to postpartum mood symptoms.
“Genome-wide data suggested that genetic variations on specific chromosomes may increase susceptibility to postpartum mood symptoms.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32] Mahon, 2009, Genome-wide linkage and follow-up association study of postpartum mood symptoms, Am J Psychiatry source
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- Premisecitation
A UK study linking childbirth with depression diagnoses and antidepressant prescriptions in over 17,000 couples over 12 years found that the incidence of depression diagnosis or antidepressant prescription was almost 14% in the first year after delivery, falling to about 6% in the second year and beyond.
“In a study conducted in the UK, Davé et al. [55] linked childbirth, and depression diagnoses and antidepressant prescriptions in medical records for couples (n > 17,000) over a 12-year period, and found that the incidence of a diagnosis of depression or a prescription for antidepressant medication was almost 14% in the first year after delivery and fell to about 6% in the second year and beyond.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [55] Davé, 2010, Incidence of maternal and paternal depression in primary care: a cohort study using a primary care database, Arch Pediatr Adolesc Med source
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- Interpretationreasoning
The findings suggest three clusters of risk factors: a history of psychiatric illness, life stress, and poor social relationships.
“What these findings suggest is that three constellations of risk factors exist: history of psychiatric illness, which may range from mild to severe, life stress, and poor social relationships.”
Quote in the paperSubstantial claim - Interpretationreasoning
The neurobiological effects of massive steroid withdrawal predispose women to postpartum depression.
“The neurobiological effects of this massive steroid withdrawal predispose to the development of postpartum depression.”
Quote in the paperSubstantial claim - Premisecitation
Studies of perinatal depression with control groups of non-pregnant and non-postpartum women have not found different depression rates across groups.
“For example, studies of perinatal depression that included control groups of non-pregnant and non-postpartum women have not found different rates of depression across groups [52,53].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [52] Cooper, 1988, Non-psychotic psychiatric disorder after childbirth. A prospective study of prevalence, incidence, course and nature, Br J Psychiatry source
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- cites [53] O'Hara, 1990, Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women, J Abnorm Psychol source
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- May combine two claims. 31
- The quote only partly states this claim. 1
- Classified as probably not a substantial claim. 7
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Premisenone givenPerinatal psychiatric disorders reduce a woman's functioning and are linked to poorer development in her child.
“Perinatal psychiatric disorders impair a woman’s function and are associated with suboptimal development of her offspring.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationA recent quantitative review found that over the first three months postpartum, broadly defined depression had a period prevalence of 19.2%, while major depression had a prevalence of 7.2%.
“For example, the most recent quantitative review of the prevalence of perinatal depression found that the period prevalence (over the first 3 months postpartum) of depression broadly defined was 19.2%, but the prevalence of the more narrowly defined (and more severe) major depression was 7.2% [9].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source
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PremisecitationRisk factors for perinatal mental illness include a prior history of depression, anxiety, or bipolar disorder, as well as psychosocial factors such as partner conflict, poor social support, and ongoing stressful life events.
“Risk factors include past history of depression, anxiety, or bipolar disorder, as well psychosocial factors, such as ongoing conflict with the partner, poor social support, and ongoing stressful life events.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [58] O'Hara, 2013, Postpartum depression: current status and future directions, Annu Rev Clin Psychol source
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InterpretationreasoningReducing, eliminating, or replacing negative biopsychosocial exposures with positive factors can improve childbearing outcomes and the later health of both mother and child.
“To the extent that negative biopsychosocial exposures can be diminished, eliminated, or replaced with positive factors, childbearing outcomes and the subsequent health of the mother of an offspring can be improved.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Premisenone givenPerinatal mental illness encompasses depression, anxiety disorders, and postpartum psychosis, with postpartum psychosis typically presenting as bipolar disorder.
“These disorders include depression, anxiety disorders, and postpartum psychosis, which usually manifests as bipolar disorder.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationHigh stress and related mental illnesses influence maternal and fetal outcomes and also affect offspring health into adulthood.
“High levels of stress and associated mental illnesses affect maternal and fetal outcomes, and also long-term offspring health into adulthood.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] Misra, 2003, Integrated perinatal health framework. A multiple determinants model with a life span approach, Am J Prev Med source
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PremisecitationThe United Kingdom Confidential Enquiry into All Maternal Deaths (1997-1999) found that 10% of postpartum deaths were from suicide and 12% from psychiatric causes.
“The United Kingdom Confidential Enquiry into All Maternal Deaths (1997–1999) [35] revealed that 10% of postpartum deaths resulted from suicide, and 12% resulted from psychiatric causes (e.g. accidental overdose, deaths from medical conditions due to substance use, and violent”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [35] Oates, 2003, Suicide: the leading cause of maternal death, Br J Psychiatry source
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PremisecitationPostpartum psychosis occurs in one or two per 1000 births.
“The incidence of postpartum psychosis is one or two per 1000 births [21].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [21] Sit, 2006, A review of postpartum psychosis, J Womens Health (Larchmt) source
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PremisecitationNegative mood symptoms peak between day 3 and day 5 postpartum, possibly reflecting hormonal readjustments after delivery.
“Negative mood symptoms have been found to peak between day 3 and day 5 postpartum, perhaps reflecting hormonal readjustments after delivery [49–51].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [49] Buttner, 2012, The structure of women's mood in the early postpartum, Assessment source
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- cites [50] O'Hara, 1995
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- cites [51] Gonidakis, 2007, Maternity blues in Athens, Greece: a study during the first 3 days after delivery, J Affect Disord source
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PremisecitationAntidepressant monotherapy for bipolar disorder may trigger rapid cycling, induce mania, or increase treatment resistance.
“Antidepressant drug monotherapy for bipolar disorder may precipitate rapid cycling, induce mania, or increase treatment resistance [40].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [40] Arvilommi, 2007, Adequacy of treatment received by diagnosed and undiagnosed patients with bipolar I and II disorders, J Clin Psychiatry source
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PremisecitationIn low- and middle-income countries, the mean prevalence of postpartum depression was estimated at 19.8%, and 15.6% during pregnancy.
“Fisher et al. [12] reported separately on prevalence of perinatal depression in low- and middle-income countries. The mean prevalence of postpartum depression in these countries was estimated to be 19.8% (15.6% during pregnancy).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] Fisher, 2012, Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review, Bull World Health Organ source
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PremisecitationFor women with bipolar disorder, the first 30 days after birth carry a relative risk of 23.3 for psychiatric admission compared with any other postpartum period, and 30-60 days after birth carry a risk of 6.3.
“For women with bipolar disorder, the first 30 days after birth carries a relative risk of 23.3 of having a psychiatric admission compared with women at any other period after birth, and 30–60 days after birth incurs a risk of 6.3 [29].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] Munk-Olsen, 2006, New parents and mental disorders: a population-based register study, JAMA source
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PremisecitationThe prevalence of depression during pregnancy was estimated at 18.4%, with 12.7% for major depression.
“The prevalence of depression across pregnancy was estimated at 18.4% (12.7% major depression).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source
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PremisecitationThe Mood Disorders Questionnaire is one of the few screening tools for bipolar disorder and the most commonly used.
“One of the few screening measures for bipolar disorder, and the most commonly used, is the Mood Disorders Questionnaire (MDQ) [38].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [38] Hirschfeld, 2000, Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire, Am J Psychiatry source
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PremisecitationObsessive-compulsive disorder rates during pregnancy ranged from 1.2% to 5.2%, and were about 4.0% at six months postpartum.
“Rates of obsessive–compulsive disorder (OCD) during pregnancy ranged from 1.2% to 5.2%, and the rate was about 4.0% at 6 months postpartum.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Wenzel, 2011
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PremisecitationIn a retrospective comparison of women with bipolar disorder receiving tertiary psychiatric care, recurrence rates over the first 40 weeks after lithium discontinuation were similar for pregnant (52%) and non-pregnant (58%) women, but both were much lower in the year before discontinuation (21%).
“Viguera et al. [37] retrospectively compared recurrence rates and survival functions for women with bipolar disorder in two groups receiving tertiary psychiatric care treatment. One group discontinued lithium during childbearing, and the other discontinued lithium but was non-childbearing. Rates of recurrence over the first 40 weeks after lithium discontinuation were similar for pregnant (52%) and”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Viguera, 2000, Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance, Am J Psychiatry source
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PremisecitationPanic disorder rates ranged from 1.4% to 9.1% during pregnancy and from 0.5% to 2.9% between six and ten weeks postpartum.
“With panic disorder, rates ranged from 1.4% to 9.1% during pregnancy and 0.5% to 2.9% between 6 and 10 weeks postpartum.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Wenzel, 2011
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PremisecitationPostpartum psychosis appears rapidly after birth with mood fluctuation, confusion, marked cognitive impairment suggestive of delirium, bizarre behaviour, insomnia, visual and auditory hallucinations, and unusual tactile or olfactory hallucinations.
“Postpartum psychosis presents rapidly after birth, with mood fluctuation, confusion, and marked cognitive impairment suggestive of delirium, bizarre behaviour, insomnia, visual and auditory hallucinations, and unusual (i.e. tactile and olfactory) hallucinations [25].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] Wisner, 1994, Symptomatology of affective and psychotic illnesses related to childbearing, J Affect Disord source
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PremisecitationPostpartum depression is generally independent of postpartum blues, but the blues are a risk factor for postpartum depression.
“Postpartum depressions are generally independent of the blues, but the postpartum blues do represent a risk factor for postpartum depression [46].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [46] O'Hara, 1991, Prospective study of postpartum blues. Biologic and psychosocial factors, Arch Gen Psychiatry source
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Premisenone givenSignificant maternal anxiety harms the developing fetus and complicates early parenting.
“Given the deleterious effects of significant maternal anxiety on the developing fetus, and the way in which it complicates early parenting, the obstetrician should be as alert for anxiety symptoms as for depressive symptoms in the perinatal period.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationPost-birth decompensation in women with bipolar disorder is caused by genetic factors and by massive gonadal steroid withdrawal after birth in women who are neurobiologically sensitive to hormonal change.
“The causes of post-birth decompensation in women with bipolar disorder include genetic factors [31–33] and massive gonadal steroid withdrawal after birth in women who are neurobiologically sensitive to hormonal change [34].”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [31] Binder, 2010, A serotonin transporter gene polymorphism predicts peripartum depressive symptoms in an at-risk psychiatric cohort, J Psychiatr Res source
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- cites [32] Mahon, 2009, Genome-wide linkage and follow-up association study of postpartum mood symptoms, Am J Psychiatry source
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- cites [33] Sanjuan, 2008, Mood changes after delivery: role of the serotonin transporter gene, Br J Psychiatry source
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- cites [34] Bloch, 2000, Effects of gonadal steroids in women with a history of postpartum depression, Am J Psychiatry source
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PremisecitationAmong women with postpartum onset major depression, 57% reported obsessional thoughts of harming their baby, and most had checking compulsions.
“In women with postpartum onset major depression, 57% reported obsessional thoughts of harm to their baby, and most had checking compulsions (i.e. highly repetitive night-time checking to make sure the baby is breathing) [44].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [44] Wisner, 1999, Obsessions and compulsions in women with postpartum depression, J Clin Psychiatry source
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PremisecitationSocial anxiety disorder rates ranged from 2.0% to 6.4% in pregnancy and from 0.2% to 6.5% in the early postpartum period.
“Finally, rates for social anxiety disorder in pregnancy ranged from 2.0% to 6.4%, and in the early postpartum period prevalence rates ranged from 0.2% to 6.5% [19].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Wenzel, 2011
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PremisecitationNo established criteria for postpartum blues exist, although O'Hara et al. adapted Handley et al.'s work and proposed diagnostic criteria that yielded a 26% prevalence rate.
“Unfortunately, no established criteria for the blues exist, although O’Hara et al. [46] adapted the work of Handley et al. [48] and proposed diagnostic criteria that led to their determination of a 26% prevalence rate.”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenBiological factors play a significant role in the development of perinatal mental illness.
“Biologic factors also play a significant role in the development of perinatal mental illness.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone givenPostpartum blues are a common and less serious affective disturbance that emerges early postpartum and has few negative sequelae.
“Postpartum blues are a common and less serious manifestation of affective disturbance, which emerge early in the postpartum period but have few negative sequelae.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationOther risk factors with smaller associations with postpartum depression include low socioeconomic status, being single, unwanted pregnancy, obstetrical stressors, and difficult infant temperament.
“Other relevant risk factors that have smaller associations with postpartum depression include low socioeconomic status, being single, unwanted pregnancy, obstetrical stressors, and difficult infant temperament.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [58] O'Hara, 2013, Postpartum depression: current status and future directions, Annu Rev Clin Psychol source
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PremisecitationMonoamine oxidase A levels were 43% higher 4-6 days after birth, leading to more rapid neurotransmitter depletion.
“Monoamine oxidase A levels were 43% greater 4–6 days after birth; therefore, neurotransmitters are more rapidly depleted.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [61] Sacher, 2010, Elevated brain monoamine oxidase A binding in the early postpartum period, Arch Gen Psychiatry source
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Probably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone givenPerinatal depression, anxiety, bipolar disorder, and postpartum psychosis are mental health problems; depression and anxiety are relatively common and serious, while bipolar disorder and psychosis are less common but can have devastating consequences for the mother and family.
“Perinatal depression, anxiety, bipolar disorder, and postpartum psychosis represent mental health problems that, in the case of depression and anxiety, are relatively common and serious, and in the case of bipolar disorder and psychosis, while relatively less common, can have devastating consequences for the mother and her family.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationBased on several meta-analyses and systematic reviews, risk factors with moderate to strong associations with postpartum depression include prior depression, depression and anxiety during pregnancy, neuroticism, low self-esteem, postpartum blues, stressful life events, poor marital relationship, and poor social support.
“On the basis of these reviews, risk factors with moderate to strong associations with postpartum depression include history of depression, depression and anxiety during pregnancy, neuroticism, low self-esteem, postpartum blues, stressful life events, poor marital relationship, and poor social support [58].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [58] O'Hara, 2013, Postpartum depression: current status and future directions, Annu Rev Clin Psychol source
Not checked in the free run.
May combine two claims.
PremisecitationIn a landmark study, Bloch et al. simulated birth-related hormone withdrawal by inducing a hypogonadal state with leuprolide, adding back supraphysiologic oestradiol and progesterone for 8 weeks, then withdrawing both steroids under double-blind conditions; five of eight women with a history of postpartum depression developed mood symptoms, compared with none of eight women without such a history,
“In a landmark study, Bloch et al. [34] simulated the withdrawal of hormones at birth by inducing a hypogonadal state in women with leuprolide, adding back supraphysiologic doses of oestradiol and progesterone for 8 weeks, then withdrawing both steroids under double-blind conditions. Five of eight women with a history of postpartum depression, compared with 0 of the 8 women without a history of”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] Bloch, 2000, Effects of gonadal steroids in women with a history of postpartum depression, Am J Psychiatry source
Not checked in the free run.
May combine two claims.
PremisecitationDepression is common among women, and the ages when women are most likely to give birth coincide with the ages when depression rates across the lifespan appear highest.
“Of course, depression is common among women, and the ages at which women are most likely to have children are those at which women seem to have the highest rates of depression across the life-span [56,57].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [56] Blazer, 1994, The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey, Am J Psychiatry source
Not checked in the free run.
- cites [57] Eaton, 2012, An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample, J Abnorm Psychol source
Not checked in the free run.
May combine two claims.
PremisecitationThe data are equivocal, and most reviews conclude that little evidence supports an increased risk of depression in the postpartum period.
“The data are equivocal, and most reviews have concluded that little evidence is available for increased risk of depression in the postpartum period [9,10].”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
Premisenone givenDuring pregnancy, the brain is exposed to a 100-fold increase in oestradiol levels, which abruptly fall in the first few days postpartum.
“During pregnancy, the brain is exposed to a 100-fold increase in oestradiol levels, which abruptly decrease in the first few postpartum days.”
Quote in the paperSubstantial claim
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The prevalence of maternal depression depends on the definition and/or the tool used to diagnose PPD.
“The prevalence of maternal depression therefore depends on the definition and/or the tool used to diagnose PPD.3,6–8”
From Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes (2019) · cites this paper as [3]
Maternal PPD is prevalent, affecting up to 20% of women within the first three months after childbirth.
“Maternal PPD is prevalent, affecting up to 20 % of women within the first three months after childbirth (O'Hara and Wisner, 2014).”
From PandaMom – Feasibility and acceptability of an internet- and mobile-based intervention to enhance peripartum mental well-being and to prevent postpartum depression (2024) · cites this paper as O'Hara and Wisner, 2014
Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status.
“Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status.”
From Perinatal Depression: Challenges and Opportunities (2021) · cites this paper as [19]
Factors with smaller associations with PPD included low socioeconomic status, single marital status, unintended pregnancy, obstetrical stressors, and an infant with a difficult temperament.
“Factors with smaller associations included low socioeconomic status, single marital status, unintended pregnancy, obstetrical stressors, and an infant with a difficult temperament.19”
From Perinatal Depression: Challenges and Opportunities (2021) · cites this paper as [19]
A 2014 review of the literature and existing meta-analyses revealed that history of depression, AND and antenatal anxiety, neurotic personality, low self-esteem, maternity blues, stressful life events, poor marital quality, and poor social support have moderate to strong associations with PPD.
“A 2014 review of the literature and existing meta-analyses revealed that the following factors have moderate to strong associations with PPD: history of depression, AND and antenatal anxiety, neurotic personality, low self-esteem, maternity blues, stressful life events, poor marital quality, and poor social support.19”
From Perinatal Depression: Challenges and Opportunities (2021) · cites this paper as [19]
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- Authors
- O'Hara, M. W., & Wisner, K. L.
- Affiliations
- Northwestern University (US)
- ORCID
- Wisner, Katherine L.
- Venue
- Best Practice & Research Clinical Obstetrics & Gynaecology
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 28
- Issue
- 1
- Pages
- 3-12
- ISSN
- 1521-6934 (ISSN-L)
- PMC
- PMC7077785
- OpenAlex
- W2071802871
- Cited by
- 986
- References
- 63
- Citations by year
- 2026: 88 · 2025: 101 · 2024: 113 · 2023: 107 · 2022: 116 · 2021: 94 · 2020: 82 · 2019: 83 · 2018: 64 · 2017: 36 · 2016: 48 · 2015: 42 · 2014: 9 · 2013: 1 · 2012: 1
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Best Practice & Research Clinical Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH071825)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- perinatal mental disorders, perinatal depression, perinatal anxiety, postpartum psychosis, bipolar disorder, postpartum blues, etiology, risk factors, screening, maternal mental health, offspring development
- MeSH terms
- Anxiety Disorders, Bipolar Disorder, Female, Humans, Mothers, Pregnancy, Depression, Postpartum, Peripartum Period
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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