Cited by 1,000Maternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal HealthcarePregnancy-related medical research

Perinatal mental illness: Definition, description and aetiology

Open access
O'Hara, Michael W., Wisner, Katherine L.·2014·Best Practice & Research Clinical Obstetrics & Gynaecology

Abstract

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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Crossref · 10.1016/j.bpobgyn.2013.09.002

Cites

63 of 63 references verified0 citation errors · 0 not checkable

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Claims the paper makes

0 of 72 cited sources checked · 0 supported · 0 flagged

  • 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
    • cites [46] O'Hara, 1991, Prospective study of postpartum blues. Biologic and psychosocial factors, Arch Gen Psychiatry source

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    • cites [47] Oakley, 1981, Medical and social factors in postpartum depression, J Obstet Gynecol source

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  • 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
    • cites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source

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    • cites [10] O'Hara, 1996, Rates and risk of postpartum depression – a meta-analysis, Int Rev Psychiatry source

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  • 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.”
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    • 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.”
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  • 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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  • May combine two claims. 31
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    Premisenone given

    Perinatal 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.”
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    Premisecitation

    A 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].”
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    • cites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source

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    Premisecitation

    Risk 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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    Interpretationreasoning

    Reducing, 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 claim
  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Perinatal 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.”
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    Premisecitation

    High 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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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The 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”
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    • cites [35] Oates, 2003, Suicide: the leading cause of maternal death, Br J Psychiatry source

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    Premisecitation

    Postpartum psychosis occurs in one or two per 1000 births.

    “The incidence of postpartum psychosis is one or two per 1000 births [21].”
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    • cites [21] Sit, 2006, A review of postpartum psychosis, J Womens Health (Larchmt) source

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    Premisecitation

    Negative 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].”
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    • 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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    Premisecitation

    Antidepressant 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].”
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    • 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

    In 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).”
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    • 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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    Premisecitation

    For 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].”
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    • cites [29] Munk-Olsen, 2006, New parents and mental disorders: a population-based register study, JAMA source

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    Premisecitation

    The 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).”
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    • cites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source

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    Premisecitation

    The 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].”
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    • 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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    Premisecitation

    Obsessive-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.”
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    • cites [19] Wenzel, 2011

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    Premisecitation

    In 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”
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    • 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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    Premisecitation

    Panic 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.”
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    • cites [19] Wenzel, 2011

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    Premisecitation

    Postpartum 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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    Premisecitation

    Postpartum 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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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Significant 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 claim
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    Premisecitation

    Post-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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    Premisecitation

    Among 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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    Premisecitation

    Social 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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  • May combine two claims.

    Premisecitation

    No 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 checked
    • cites [46] O'Hara, 1991, Prospective study of postpartum blues. Biologic and psychosocial factors, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [48] Handley, 1980, Tryptophan, cortisol and puerperal mood, Br J Psychiatry source

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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Biological 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 claim
  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Postpartum 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 claim
  • May combine two claims.

    Premisecitation

    Other 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

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Monoamine 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 given

    Perinatal 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 claim
  • May combine two claims.

    Premisecitation

    Based 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.

    Premisecitation

    In 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

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  • May combine two claims.

    Premisecitation

    Depression 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

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    • 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

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  • May combine two claims.

    Premisecitation

    The 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 checked
    • cites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source

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    • cites [10] O'Hara, 1996, Rates and risk of postpartum depression – a meta-analysis, Int Rev Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    During 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
34 of 34

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”
  • 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).”
  • 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)
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)
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
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

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