Science & Technology/Postpartum Depression a Major Public Health Problem That Requires More Resources, Pitt Researchers Write

JAMA editorial notes childbearing creates unique vulnerability for psychiatric illness, making screening, education, and treatment essential

Childbearing is a potent event in the lives of women, a particularly vulnerable time for developing or exacerbating psychiatric illness, Pitt School of Medicine researchers wrote in an editorial published in the Journal of the American Medical Association (JAMA) Dec. 6.

The editorial, in response to a large Danish study of perinatal psychiatric episodes, calls for greater attention to the mental health of mothers and education, screening, and treatment programs.

After giving birth, one in seven mothers will experience some form of depression that impairs their ability to function, studies have shown. Many of them will be undiagnosed and untreated. This creates a major public health problem, say experts from Pitt and the University of California, San Diego.

“Postpartum depression not only affects the mother. It touches the father, other children in the family, and, most importantly, the newborn,” said Katherine L. Wisner, professor of psychiatry and obstetrics, gynecology, and reproductive sciences in Pitt’s medical school and an associate investigator at the Magee-Womens Research Institute. “Knowing what we do about the risks of postpartum depression, we must recognize our responsibility to address this illness through improved research and greater access to care and services.”

The Danish study, which was published in the same issue of JAMA, was the first large-scale epidemiological examination of psychiatric illness during childbearing to be completed in more than 20 years. Researchers found that women were at much higher risk of hospitalization for psychiatric conditions during the three months after birth than were women who were 12 months postpartum. The risks were greatest for those giving birth to their first children.

According to Wisner, other research has shown that postpartum depression disrupts the relationship between mother and infant, which can do short- and long-term harm. Maternal depression can negatively impact a newborn’s mental and motor development and is associated with poor self-regulation, low self-esteem, and behavior problems. Postpartum depression also has a dramatic impact on the mother’s ability to function, enjoy relationships, cope with stress, and appreciate the joys of parenthood.

Wisner noted that the United States has not, until recently, prioritized postpartum illness as a major public health concern. In fact, the Agency for Healthcare Research and Quality has reported that while much is known about the risks and vulnerabilities of the postpartum period, substantial high-quality research is significantly lacking in this area.

Based on the recent study and past findings, Wisner recommended in the JAMA editorial that the United States implement a universal screening program, in which all women would be screened between two and 12 weeks postpartum. Those showing symptoms of psychiatric disorders should be treated immediately after diagnosis, she argued.

New Jersey was the first state to address the problem on the governmental level by legislating that all women receive screening and education for postpartum depression; the law went into effect in October 2006.

Pitt is conducting the first large-scale National Institute of Mental Health-funded trial of screening, treatment preference, and depression-care-management methods.

Researchers hope that information gained through this study will be used to develop universal best practices for screening and treatment.

For more information about the Pitt study or postpartum depression care at Women’s Behavioral HealthCARE of Western Psychiatric Institute and Clinic, call 1-800-436-2461 or 412-586-9072, or visit www.womensbehavioralhealth.org.

Women outside of the Pittsburgh area seeking more information or treatment should contact Postpartum Support International, www.postpartum.net/, 1-800-944-4PPD.