What physiological factors contribute to postpartum depression

Predictors of Postpartum Depression

content

Summary

introduction

1. Pathophysiology of PPD and drug treatment
1.1 Abnormal neurosteroid regulation
1.2 Drug treatment of PPD
1.3 Randomized clinical trials

2. Predictors of PPD
2.1 Psychosocial and psychological factors
2.2 The “baby blues” / maternity blues as a predictor of the PPD
2.3 Stress and quality of the partnership as predictors of the PPD

3. Early detection and prevention of PPD
3.1 Strongest predictors of the PPD
3.2 Psychosocial and psychological interventions

4. Discussion

literature

Summary

Pregnancy, childbirth and the first few months with a newborn are extremely challenging for every woman. During this time of increased vulnerability, mood disorders and mental disorders often occur. Postpartum depression (PPD) is assumed to have a prevalence of 3% to 25% (of all women in the first year after giving birth). Research into the causes or research into possible predictors of PPD has not yet been able to isolate a singular, causal factor. In general, a multifactorial etiology of PPD is assumed. The following work would like to compile possible predictors and present the results of corresponding studies for research into the causes of PPD. Finally, the early detection of PPD and the possibilities of preventive measures will be discussed.

introduction

Pregnancy and childbirth represent extreme physical and psychological challenges for every expectant mother. "Pregnancy and peripartum / perinatal periods are characterized by significant biologic as well as psychosocial processes and changes ..." writes Halbreich (2005, p.1312). It is therefore not surprising that mood swings and disorders of well-being are often associated with this special life span. The severity of mood disorders in the postnatal phase varies from mild and temporary "baby blues", which occurs in around 50% to 80% of all women, to postpartum psychosis, which affects less than 1% of all mothers, and immediate hospitalization the person concerned has to lead (Evins, 1997; quoted from Dennis & Hodnett, 2007, p. 2). Among all symptomatic manifestations in the postnatal period, postpartum depression (PPD) is known as a non-psychotic depressive disorder that occurs in the first year after giving birth or extends over the first year after giving birth. Symptoms are malaise, irritability, confusion and forgetfulness, insomnia, inability to be happy, tiredness, fear, feelings of guilt, inability to cope with one's own life situation, and even thoughts of suicide. PPD occurs most frequently in the twelve weeks after giving birth and has a duration that depends on the severity of the condition (Cox, 1993; quoted from Dennis & Hodnett, 2007, p. 2). The PPD is a serious health problem for many women from different cultures. Longitudinal studies and epidemiological studies show very different prevalences, which vary from only 3% to more than 25% (women in the first year after giving birth). The very different rates are due to differences in the samples, the times of diagnosis, the diagnostic criteria and the study designs. Thus, retrospective studies usually come to significantly lower rates than prospective studies (Dennis & Hodnett, 2007, p.2). Halbreich (2005, p.1314) even assumes that the prevalence of PPD varies between 0% and 60% depending on the mother's country of origin. He criticizes that a restriction to the PPD, which is usually measured using the Postnatal Depression Scale (EPDS) or the Beck Depression Inventory, is too narrow. A whole range of different postpartum disorders and symptoms are known, such as various anxiety disorders or disorders of the mother-child relationship. Postpartum symptoms of the central nervous system (CNS), the autoimmune system and the endocrine system, which lead to disorders of mood, behavior and cognition, are largely neglected in the psychiatric literature.

It has been shown that children under 3 months of age perceive their mothers' affective mood and adjust their own behavior accordingly. Children of mothers with PPD usually develop poorer cognitive abilities and often have behavioral problems (Dennis & Hodnett, 2008, p.2). Child neglect and abuse is a global phenomenon. Depressive symptoms of the mother have proven to be a consistent predictor of future negative parental behavior (screaming, hitting, shaking) towards children (Halbreich, 2005, p.1317). And women who suffer from PPD run a twofold risk of going through another depression in the next five years (Cooper & Murray, 1995; quoted in McQueen et al., 2008, p.127). Preventing maternal depression should be a real public health concern in order to prevent or at least reduce problematic developments in children and future parents. The following work aims to investigate which risk factors favor the development of a PPD. The topic is to be worked out on the basis of current studies and results.

1. Pathophysiology of PPD and drug treatment

The following section will outline the biophysiological causes of PPD. This is done to understand the physiological vulnerability of the female organism during and after pregnancy and with regard to the possibilities of drug treatment of PPD.

1.1 Abnormal neurosteroid regulation

Differing concentrations of neurosteroids in the central nervous system (CNS) are associated with various psychiatric and neurological disorders such as premenstrual syndrome (PMS), menstrual migraines, depression in general, PPD in particular, and various anxiety disorders (Maguire & Mody, 2008 ). Decreased neurosteroid concentrations were found in patients with depression, while antidepressants lead to an increase in neurosteroid concentrations. Their therapeutic benefit is attributed to it. Physiologically, the various postnatal mood disorders seem to be triggered by the rapid decline in reproductive hormones after pregnancy. On the other hand, exogenous administration and renewed withdrawal of steroids, which is supposed to mimic the hormonal changes of pregnancy, only lead to depressive symptoms in women with a history of PPD (Bloch et al. 2000; quoted in Maguire & Mody, 2008). This suggests that these women are predisposed. The exact cause of the predisposition has not yet been clarified (Magiure & Mody, 2008, p.207).

1.2 Drug treatment of PPD

PPD is a disease that often remains undiagnosed and is therefore not treated. The women concerned shy away from talking to their family doctor, gynecologist or pediatrician about their problem, as the fear of being stigmatized as a “bad” mother or “crazy” or with a psychiatric problem prevents them (Pearlstein, 2008, p .308). So far, very few studies have been conducted into the treatment of PPD with antidepressants and there is still no drug approved by the American Food and Drug Administration (FDA) for the treatment of PPD. Breastfeeding mothers are excluded from most studies. It is generally assumed that drugs used to treat MDD (major depressive disorder) are also effective against PPD, but this has never been systematically investigated. Some aspects of PPD are unique, such as the extreme fluctuations in hormonal balance described above, the possible influence of breastfeeding on mood, sleep deprivation and stress from the newborn. Despite ethical concerns because of the harmful effects of PPD on children, placebo control studies alone can ultimately prove the effectiveness of drug treatments (Pearlstein, 2008, p.308).

1.3 Randomized clinical trials

In a clinical study by Appleby et al. (1997) the drug treatment by Fluoxetine is investigated in a study group with a control group, which only receives counseling interviews. The sample includes a total of 87 women. Breastfeeding mothers and women with depression for more than 2 years were excluded from the study. The random assignment is made to one of the following four groups:

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