Contributors to, and predictors of Postnatal Depression
It is accepted knowledge that women experience a range of similar PND symptoms although not all concurrently nor to a similar degree.
However, there are recognised risk factors that distinguish one PND case from another and can aid medical practitioners in the early identification of at-risk mothers. The literature shows that certain environmental (such as stressful life events, marital conflict and lack of social support, O’Hara 1991) and psychological pre-conditions (such as a history of depression, Neiland and Roger 1997, Lelong et al 2007, Howell et al 2005) increase a woman’s risk of experiencing PND.
In addition, certain personality traits such as high standards, desire for control and perfectionist tendencies, along with excessive self-criticism have been identified by Luyten and Vliegen (2009) and corroborated by other studies (including Breese McCoy et al 2006) as associated with and exacerbating PND.
Other factors include, but are not limited to, breast versus bottle feeding, tobacco use, a history of depression, single parenting and socio-economic status. (See Beck, 2001 for a more complete list, Whiffen 1988, Howell et al 2005).
While there is still some support for the notion that PND is the result of a biochemical imbalance brought about by the process of childbearing and the ensuing physical changes a women’s body goes through during this period, the majority of the research disagrees with contributors such as Beck (2001) and O’Hara (1997) saying that all women experience similar physiological changes postpartum which does not explain why some women suffer while others do not.
While not all causes of PND are known, a number of factors have been identified as predictors of Postnatal Depression.
- Formula feeding rather than breast feeding
- A history of depression
- Cigarette smoking
- Low self esteem
- Childcare stress
- Prenatal depression during pregnancy
- Prenatal anxiety
- Life stress
- Low social support
- Poor marital relationship
- Infant temperament problems/colic
- Single parent
- Low socioeconomic status
- Unplanned/unwanted pregnancy
- Depression during the pregnancy
Of these, three factors - formula feeding, a history of depression, and cigarette smoking - have been shown to be additive effects.
Sarah J. Breese McCoy (April 2006). "Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature". The Journal of the American Osteopathic Association (JAOA) 106 (4): 193–8. PMID 16627773
Beck C.T. (1995). "The effects of postnatal depression on maternal-infant interaction: a meta-analysis". Nursing Research 44 (5): 298–304.
At Risk groups and individuals
You may have a higher chance of post-partum depression if you:
- Had a mood or anxiety disorder prior to pregnancy, including depression with a previous pregnancy
- Have a close family member who has had depression or anxiety
- Had something stressful happened to you during the pregnancy, including illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or abnormality in the baby
- Are under age 20
- Did not plan the pregnancy or do not want the pregnancy
- Currently abuse alcohol, take illegal substances, or smoke (these are also serious medical health risks for the baby)
- Have little support from family, friends, and a significant other
- Have a poor relationship with your husband, boyfriend, or significant other or are unmarried
- Previously attempted suicide
- Have financial problems (low income, poor housing)
- Received poor support from your parents in childhood
In addition to Beck’s (2001) meta-analysis cited above, other academic studies have shown a correlation between a mother’s race, social class and/or sexual orientation and Postnatal Depression.
In 2006 Segre et al, conducted a study "on the extent to which race/ethnicity is a risk factor" for PPD. Studying 26,877 postpartum women they found that 15.7% were depressed. Of the women suffering from PPD, 25.2% were African American, 22.9% were American Indian/Native Alaskan, 15.5% were White, 15.3% were Hispanic, and 11.5% were Asian/Pacific Islander. Even when "important social factors such as age, income, education, marital status, and baby’s health were controlled, African American women still emerged with significantly increased risk for…PND".
Segre et al, also found a correlation between a mother’s social class and PND. Not surprisingly, women with fewer resources indicate a higher level of postpartum depression and stress than those with more financial resources. Rates of PND decreased as income increased as follows:
<$10,000 — 24.3%
$10,000-$19,000 — 20.0%
$20,000-$29,000 — 18.8%
$30,000-$39,000 — 15.3%
$40,000-$49,000 — 13.7%
$50,000 — 10.8%
Likewise, a study conducted by Howell et al. in 2006 confirms Segre’s findings that women who are nonwhite and in lower socioeconomic categories have more symptoms of PND.
In a 2007 study conducted by Ross et al, lesbian and bisexual mothers were tested for PND and then compared with a heterosexual sample. Ross et al found that "lesbian and bisexual biological mothers had significantly higher Edinburgh Postnatal Depression Scale (EPDS) scores than the…sample of heterosexual women."
The Ross study suggests that PND may be more common among lesbian and bisexual mothers. From a study conducted in 2005 by Ross, the higher rates of PPD in lesbian/bisexual mothers than heterosexual mothers may be due to less "social support, particularly from their families of origin and…additional stress due to homophobic discrimination" in society.
Sometimes depression following pregnancy can be related to other medical conditions. Hypothyroidism for example, causes symptoms such as fatigue, irritability, and depression. Women with Postnatal Depression should have a blood test to screen for low thyroid hormones.