Depression Mental Woes More Common in First

Depression, Mental Woes More Common in First-Time Moms

The risk is highest in first months after birth, study finds

By Serena Gordon
HealthDay Reporter

TUESDAY, Dec. 5 (HealthDay News) -- Women who have recently given birth to their first child have a higher risk of hospitalization for mental disorders, such as depression, than other women.

But, new fathers don't seem to share a similar increased risk of serious mental illness after the birth of their first child.

Those are just two of the findings from a 22-year study, published in the Dec. 6 issue of the Journal of the American Medical Association, that followed more than 2 million Danish-born adults throughout their lifetimes.

"Our study shows that women are particularly at risk of hospital admission for mental disorders just after having become a mother for the first time," said the study's lead author, Trine Munk-Olsen, a doctoral student at the National Centre for Register-Based Research at the University of Aarhus in Denmark.

"New fathers, however, do not appear to be at risk," she added. This suggests that hormonal fluctuations likely play a role in these disorders.

Depression after the birth of a child is very common in women, affecting up to 15 percent of new mothers, according to background information for the study. Other serious mental illnesses, while not as prevalent, may also affect new mothers in greater numbers. The study reports that postpartum psychosis, a serious mental disorder that can put both the baby and mother at risk for physical harm, affects about one woman out of every 1,000 births.

Munk-Olsen and her colleagues noted that most previous studies of first-time mothers hadn't looked for other mental disorders, such as bipolar disorder or schizophrenia. Additionally, few studies have looked at the impact of new parenthood on a father's mental health.

To assess the risk of all psychiatric illnesses severe enough to require hospitalization in both mothers and fathers, the researchers gathered information from Danish health and civil-service registers. These registers contained information on 2,357,942 adults born in Denmark. The researchers included information from 1973 through 2005.

During that time period, 630,373 women and 547,431 men became parents for the first time.

Of those new parents, 1,171 women and 658 men had to be admitted to a psychiatric hospital at some point during the first 12 months of their child's life. Overall, the risk of hospitalization for mental illness was 1.03 per 1,000 births for women and 0.37 per 1,000 births for men within three months of the birth of a child.

Women who had given birth within the last three months were more than seven times as likely to be hospitalized, compared to women who had given birth 11 months to 12 months earlier. Women who had given birth within the previous three months were also more than twice as likely to seek outpatient mental-health care. The highest risk occurred at 10 days to 19 days after birth.

"This study is important because it replicates the findings of earlier research," said Dr. Dorothy Sit, an assistant professor of psychiatry at the University of Pittsburgh School of Medicine, and one of the authors of an accompanying editorial in the journal.

"Women need to get treatment immediately. Although depression may resolve between six and nine months spontaneously, the consequences are wide-ranging," she explained. "Depression impairs not only the mother's function, not only socially and at work, but it can impact her relationship with her newborn and her other children."

She said women, their families and their health-care providers need to be aware of the increased risk of depression and other disorders following the birth of a first child.

In particular, Sit said, women who've had past depression are at increased risk. Symptoms to watch for include: a loss of interest in the baby or in other once-pleasurable activities; feeling down or depressed; changes in sleep patterns; thoughts of wanting to die; new onset of anxiety or thoughts of wanting to harm one's self or others.

"Be ready to seek treatment sooner rather than later," Sit advised, adding there are both medical and non-medical options for the treatment of psychiatric disorders, and there are medications thought to be safe for breast-feeding mothers.

More information

To learn more about depression and pregnancy, visit the U.S. National Women's Health Information Center.

SOURCES: Trine Munk-Olsen, doctoral student, the National Centre for Register-Based Research, University of Aarhus, Denmark; Dorothy Sit, M.D., assistant professor of psychiatry, University of Pittsburgh School of Medicine; Dec. 6, 2006, Journal of the American Medical Association

First-Time Mothers At Increased Risk For Postpartum Mental Disorders

December 6, 2006

New mothers are at an increased risk for mental disorders such as schizophrenia, depression and bipolar disorder in the 3 months following the birth of their first child, according to a study in the December 6 issue of JAMA. The study also found that first-time fathers do not have an increased risk for mental disorders.

Postpartum depression is a serious mental health problem for women and their families, with an estimated prevalence of about 10 percent to 15 percent among mothers. Postpartum disorders can also include more severe mental disorders, with a prevalence of about 1 per 1,000 births, according to background information in the article. There is some indication that a small percentage of men experience postpartum depression, but the possible relationship between becoming a father and first onset of mental disorders has not been established.

Trine Munk-Olsen, M.Sc., of the University of Aarhus, Denmark and colleagues conducted a study to estimate the risk of postpartum mental disorders requiring hospital admission or outpatient contact for first-time mothers and fathers up to 12 months after becoming a parent. The researchers analyzed data from Danish health and civil service registers, which for this study included a total of 2,357,942 Danish-born persons who were followed up from their 15th birthday or January 1973, whichever came later, until date of onset of the disorder in question, date of death, date of emigration from Denmark, or July 2005, whichever came first.

From 1973 to 2005, a total of 630,373 women and 547,431 men became parents for the first time. A total of 1,171 women and 658 men were admitted with a mental disorder to a psychiatric hospital during the first 12 months after parenthood, and the corresponding prevalence of severe mental disorders through the first 3 months after childbirth was 1.03 per 1,000 births for mothers and 0.37 per 1,000 births for fathers. For first-time mothers, the first weeks and months after the delivery were associated with an increased risk of first admission with any mental disorder, and the period from 10 to 19 days following the birth was associated with the highest risk (7.3 times increased risk) compared with women who had given birth 11 to 12 months previously. The increased risk of admission among mothers remained statistically significant through the first 3 months after childbirth regardless of age of the mother. Risk for mothers was also increased for psychiatric outpatient contacts through the first 3 months after childbirth, also with the highest risk occurring 10 to 19 days following the birth.

Unlike motherhood, fatherhood was not associated with any increased risk of hospital admission or outpatient contact. "This may indicate that the causes of postpartum mental disorders are more strongly linked to an altered physiological process related to pregnancy and childbirth than psychosocial aspects of motherhood."

"Accurate estimates of the rates of and risk factors for postpartum depression are highly important for the scientific and clinical understanding of mental and behavioral disorders during the postpartum period as well as for planning mental health services for childbearing women and their families," the authors write.

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(JAMA. 2006;296:2582-2589.)

This study was supported by the Stanley Medical Research Institute, Chevy Chase, Md. Psychiatric epidemiological research at the National Centre for Register-Based Research is in part funded through a collaborative agreement with the Centre for Basic Psychiatric Research, Psychiatric Hospital, Aarhus, Denmark. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Postpartum Depression - A Major Public Health Problem

In an accompanying editorial, Katherine L. Wisner, M.D., M.S., of the University of Pittsburgh Medical Center, and colleagues comment on the findings concerning postpartum depression.

"These collective data [Munk-Olsen et al and other studies] emphasize the importance of recognizing childbearing as a potent health factor in the life course of women. Childbearing influences the course of any disease state and acts as a biopsychosocial factor that may precipitate new episodes of illness. The data also provide evidence to inform and support universal screening for postpartum mood episodes. The studies converge on the time frame of elevated risk for both hospitalization and outpatient contacts as the first 3 months postpartum, particularly in primiparae [first birth], independent of considerations of diagnosis," they write. "Therefore, screening should be implemented as early as 2 weeks after delivery and no later than 12 weeks postpartum to identify episodes of major mood disorder and other mental illnesses."

"Effective treatments for these episodes exist. Rapid implementation of treatment is prudent because mood episodes can be lengthy and psychosocial sequelae increase with duration. Maternal depression exacts a heavy toll on women's functioning and the health and well-being of their children. … Mental health is crucial to a mother's capacity to function optimally, enjoy relationships, prepare for the infant's birth, and cope with the stresses and appreciate the joys of parenthood."

(JAMA. 2006;296:2616-2618.)

Please see the editorial for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Contact: Trine Munk-Olsen
JAMA and Archives Journals

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