Predictors, prodromes and incidence of postpartum depression

The purpose of this study was to determine the incidence of clinically sign ificant depression occurring between 1 and 4 months postpartum and to inves tigate whether somatic complaints subsyndromal depressive symptoms, or birt h-related concerns among non-depressed women at 1 month were predictive of postpartum depression. This is a prospective cohort study of 465 women from the Wisconsin Maternity Leave and Health Project (WMLHP). Women who were n ot depressed at 1 month postpartum were reassessed 3 months later for depre ssion occurring at any time in the interval between 1 and 4 months postpart um. Depression was defined as either meeting the criteria for major depress ion on the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) or scoring above 15 on the Center for Epidemiologic Studies Depression Scale (CES-D). Physical symptoms were assessed by an adapted Hea lth Responses Scale. Other measures were developed specifically for the WML HP. Of 465 women, 27 (5.8%) became clinically depressed between 1 and 4 mon ths postpartum. In a logistic regression analysis, four variables (maternal age, depression during pregnancy, thoughts of death and dying at I month p ostpartum, and difficulty falling asleep at 1 month postpartum) were predic tive of depression at 4 months postpartum. Breast-feeding, mode of delivery family income, parity and mother's education did not predict depression. T he existence of subsyndromal depressive symptoms, particularly thoughts of death and dying, may represent a prodromal phase of depression and should a lert clinicians to the possibility of future postpartum depression. Women w ith a history of depression during pregnancy should be monitored for signs of postpartum depression for a minimum of 4 months. Obstetricians are in a unique position during the postpartum check-up to screen women for these pr edictors of future postpartum depression and possibly to avert the developm ent of a clinically significant depressive episode.