Postnatal depression: risk factors and preventive measures.

The authors examine the risk factors that could initiate postnatal depressi on, considering simultaneously the field of external reality and the intrap sychic reality of the mother. They first emphasise the role of environmenta l factors (breakdown of the supporting structure, societal idealisation of the concept of maternity, living conditions and socioeconomic status of the mother, primiparity, presence of a dead child or a previous bereavement, h andicap or pathology in the child). They then consider the influence of int rapsychic factors (nature of the maternal image, nature of the identificati on in the mother, influence of early affective imbalances, bereavement conc erning the imaginary child and of the ideal mother, difficulty in symbolizi ng childbirth). Finally, the authors examine the therapeutic means that sho uld be introduced in anticipation of the damaging consequences of postnatal depression. These preventive measures presuppose prior detection of such a state, which could take place during the pregnancy or in the weeks followi ng childbirth; then, as rapidly as possible, the initiation of therapeutic treatment, depending on whether this is an opportune period for the mother to undertake psychological work, and to the extent that it involves avoidin g the risk of a lasting pathogenic mother-child bond being formed. (C) 1999 Elsevier, Paris.