Perinatal mental illness: Definition, description and aetiology

In the paper

“Perinatal psychiatric disorders impair a woman’s function and are associated with suboptimal development of her offspring.”

In the paper

“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].”

What the sources say

• Not checked yetcites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source

In the paper

“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.”

What the sources say

• Not checked yetcites [58] O'Hara, 2013, Postpartum depression: current status and future directions, Annu Rev Clin Psychol source

In the paper

“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.”

In the paper

“These disorders include depression, anxiety disorders, and postpartum psychosis, which usually manifests as bipolar disorder.”

In the paper

“High levels of stress and associated mental illnesses affect maternal and fetal outcomes, and also long-term offspring health into adulthood.”

What the sources say

• Not checked yetcites [6] Misra, 2003, Integrated perinatal health framework. A multiple determinants model with a life span approach, Am J Prev Med source

In the paper

“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”

What the sources say

• Not checked yetcites [35] Oates, 2003, Suicide: the leading cause of maternal death, Br J Psychiatry source

In the paper

“The incidence of postpartum psychosis is one or two per 1000 births [21].”

What the sources say

• Not checked yetcites [21] Sit, 2006, A review of postpartum psychosis, J Womens Health (Larchmt) source

In the paper

“Negative mood symptoms have been found to peak between day 3 and day 5 postpartum, perhaps reflecting hormonal readjustments after delivery [49–51].”

What the sources say

• Not checked yetcites [49] Buttner, 2012, The structure of women's mood in the early postpartum, Assessment source
• Not checked yetcites [50] O'Hara, 1995
• Not checked yetcites [51] Gonidakis, 2007, Maternity blues in Athens, Greece: a study during the first 3 days after delivery, J Affect Disord source

In the paper

“Antidepressant drug monotherapy for bipolar disorder may precipitate rapid cycling, induce mania, or increase treatment resistance [40].”

What the sources say

• Not checked yetcites [40] Arvilommi, 2007, Adequacy of treatment received by diagnosed and undiagnosed patients with bipolar I and II disorders, J Clin Psychiatry source

In the paper

“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).”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [29] Munk-Olsen, 2006, New parents and mental disorders: a population-based register study, JAMA source

In the paper

“The prevalence of depression across pregnancy was estimated at 18.4% (12.7% major depression).”

What the sources say

• Not checked yetcites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source

In the paper

“One of the few screening measures for bipolar disorder, and the most commonly used, is the Mood Disorders Questionnaire (MDQ) [38].”

What the sources say

• Not checked yetcites [38] Hirschfeld, 2000, Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire, Am J Psychiatry source

In the paper

“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.”

What the sources say

• Not checked yetcites [19] Wenzel, 2011

In the paper

“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”

What the sources say

• Not checked yetcites [37] Viguera, 2000, Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance, Am J Psychiatry source

In the paper

“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.”

What the sources say

• Not checked yetcites [19] Wenzel, 2011

In the paper

“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].”

What the sources say

• Not checked yetcites [25] Wisner, 1994, Symptomatology of affective and psychotic illnesses related to childbearing, J Affect Disord source

In the paper

“Postpartum depressions are generally independent of the blues, but the postpartum blues do represent a risk factor for postpartum depression [46].”

What the sources say

• Not checked yetcites [46] O'Hara, 1991, Prospective study of postpartum blues. Biologic and psychosocial factors, Arch Gen Psychiatry source

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [31] Binder, 2010, A serotonin transporter gene polymorphism predicts peripartum depressive symptoms in an at-risk psychiatric cohort, J Psychiatr Res source
• Not checked yetcites [32] Mahon, 2009, Genome-wide linkage and follow-up association study of postpartum mood symptoms, Am J Psychiatry source
• Not checked yetcites [33] Sanjuan, 2008, Mood changes after delivery: role of the serotonin transporter gene, Br J Psychiatry source
• Not checked yetcites [34] Bloch, 2000, Effects of gonadal steroids in women with a history of postpartum depression, Am J Psychiatry source

In the paper

“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].”

What the sources say

• Not checked yetcites [44] Wisner, 1999, Obsessions and compulsions in women with postpartum depression, J Clin Psychiatry source

In the paper

“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].”

What the sources say

• Not checked yetcites [19] Wenzel, 2011

In the paper

“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.”

What the sources say

• Not checked yetcites [46] O'Hara, 1991, Prospective study of postpartum blues. Biologic and psychosocial factors, Arch Gen Psychiatry source
• Not checked yetcites [48] Handley, 1980, Tryptophan, cortisol and puerperal mood, Br J Psychiatry source

In the paper

“Biologic factors also play a significant role in the development of perinatal mental illness.”

In the paper

“Postpartum blues are a common and less serious manifestation of affective disturbance, which emerge early in the postpartum period but have few negative sequelae.”

In the paper

“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.”

What the sources say

• Not checked yetcites [58] O'Hara, 2013, Postpartum depression: current status and future directions, Annu Rev Clin Psychol source

In the paper

“Monoamine oxidase A levels were 43% greater 4–6 days after birth; therefore, neurotransmitters are more rapidly depleted.”

What the sources say

• Not checked yetcites [61] Sacher, 2010, Elevated brain monoamine oxidase A binding in the early postpartum period, Arch Gen Psychiatry source

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [58] O'Hara, 2013, Postpartum depression: current status and future directions, Annu Rev Clin Psychol source

In the paper

“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”

What the sources say

• Not checked yetcites [34] Bloch, 2000, Effects of gonadal steroids in women with a history of postpartum depression, Am J Psychiatry source

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [57] Eaton, 2012, An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample, J Abnorm Psychol source

In the paper

“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].”

What the sources say

• Not checked yetcites [9] Gavin, 2005, Perinatal depression: a systematic review of prevalence and incidence, Obstet Gynecol source
• Not checked yetcites [10] O'Hara, 1996, Rates and risk of postpartum depression – a meta-analysis, Int Rev Psychiatry source

In the paper

“During pregnancy, the brain is exposed to a 100-fold increase in oestradiol levels, which abruptly decrease in the first few postpartum days.”