Who is most at risk for postnatal depression?

Thank you for asking such an important question. It is important as women who have postnatal depression may harm themselves and/or their babies.

Postnatal depression is moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later later. At my clinic, most of the women report that their mood symptoms start within the first three months after delivery.

The following are important factors to appreciate when trying to grasp postnatal depression:

1. Changes in hormone levels during and after pregnancy may affect a woman's mood

2. Changes in the body from pregnancy and delivery. All this may affect the woman's body image and self esteem.

3. Changes in work, daily routines and social relationship

4. Having less time and freedom to pursue one's own interests and activities

5. Sleep deprivation

6. Worries about one's ability to be an effective mother

The following are important risk factors for postnatal depression:

1. Depression during pregnancy is the best predictor of postnatal depression

2. Prenatal anxiety -- this also relates to one's preparedness to be a parent and worries about one's ability to be a good parent

3. History of depression or mood disorders, especially postnatal depression

4. Recently having stopped antidepressants prior to pregnancy

5. Family history of depression and mood disorders

6. Pregnancy or obstetrical complications at delivery. Stressful event during pregnancy or delivery include personal illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery or illness or birth defects in the baby.

Other risk factors of postnatal depression include:

1. Age less than 20

2. Currently uses alcohol, illegal substances or smokes

3. Did not plan the pregnancy, or had mixed feelings about the pregnancy

4. Has a poor relationship with significant other or is single

5. Has financial or housing problems

6. Has little support from family, friends, spouse or partner

It is important to seek treatment early as postnatal depression can be effectively treated with counselling (psychotherapy) and medications. The outcome is often a favourable one. During treatment it is important to involve the spouse or partner as well.

Various factors are associated with a higher risk for Postpartum depression. These factors are delineated in a narrative review by Ghaedrahmati et al [1].

You may read this article for more information about other Postnatal Mental Conditions.

Factors Causing Higher Risk of Post Partum Depression:

Psychological Risk Factors:

• Previous history of depression and anxiety
• The occurrence of mental health disorders such as depression during pregnancy
• A negative attitude toward the recent pregnancy, number of life events
• History of sexual abuse in the past
• The reluctance of the baby gender
• Having low self-esteem with the impact on parenting stress etc.

Obstetric Risk Factors:

• Multiparity (having borne more than 1 child)
• Risky pregnancy—conditions that lead to emergency cesarean section or hospitalization during pregnancy
• Postpartum complications— meconium passage, umbilical cord prolapse, and obstetric hemorrhages
• The birth of an infant with a weight <1500 g.

Biological Risk factors:

• Young age
• Glucose metabolism disorders etc.

Social Risk Factors:

• Spouse sexual violence
• Other forms of domestic violence during pregnancy
• smoking during prenatal period etc.

Lifestyle Risk Factors:

• Reduced intake of zinc and selenium
• Less sleep etc.

Reference:

[1] Ghaedrahmati M, Kazemi A, Kheirabadi G, Ebrahimi A, Bahrami M. Postpartum depression risk factors: A narrative review. J Educ Health Promot. 2017;6:60. Published 2017 Aug 9. doi:10.4103/jehp.jehp916