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group_3_presentation_2_-_postpartum_depression [2018/03/02 21:34] duruf [Pharmacological Treatment of Postpartum Depression] |
group_3_presentation_2_-_postpartum_depression [2018/03/02 21:47] (current) duruf [Postpartum Psychosis] |
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| ==== Postpartum Depression ==== | ==== Postpartum Depression ==== | ||
| - | PPD easily ranks as one of the most common complication associated with childbirth. It is estimated to occur in one out of every eight women after delivery, that is roughly half a million women in the USA alone with this disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, the onset of postpartum depression is believed to occur within four weeks of a prior episode of depression. Scientifically however, researchers rely on the onset of postpartum depression within three months of delivery for the purpose of epidemiological studies. In addition to the symptoms of baby blues women experiencing postpartum depression will display symptoms that interfere with their daily living. These include, lack of joy, sense of emotional numbness and failure, insomnia, severe mood swings. This is considered a more moderate form of depression that affects up to an estimated 10% to 13% of women after childbirth. | + | PPD easily ranks as one of the most common complication associated with childbirth. It is estimated to occur in one out of every eight women after delivery, that is roughly half a million women in the USA alone with this disorder (Sit, Rothschild and Wisner, 2006). According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the onset of postpartum depression is believed to occur within four weeks of a prior episode of depression. Scientifically however, researchers rely on the onset of postpartum depression within three months of delivery for the purpose of epidemiological studies (Sit, Rothschild and Wisner, 2006). In addition to the symptoms of baby blues women experiencing postpartum depression will display symptoms that interfere with their daily living. These include, lack of joy, sense of emotional numbness and failure, insomnia, severe mood swings. This is considered a more moderate form of depression that affects up to an estimated 10% to 13% of women after childbirth (Sit, Rothschild and Wisner, 2006). |
| ==== Postpartum Psychosis ==== | ==== Postpartum Psychosis ==== | ||
| - | A more severe and rare form of PPD is Postpartum psychosis. Postpartum psychosis is believed to be a manifestation of bipolar disorder (Sit, Rothschild and Wisner, 2006). It is estimated to occur in one to two women per 1000 births within the first two to four weeks after childbirth. Unlike postpartum baby blues and postpartum depression, postpartum psychosis is a psychiatric emergency that requires immediate professional treatment due to severe symptoms such as hallucinations, paranoia, delusions and self-harming thoughts that could potentially result in suicide or infanticide (Sit, Rothschild and Wisner, 2006)(Beck, 2006). As a result women with postpartum psychosis must never be left alone, they must be under supervision 24hours of the day as they are a risk to themselves and their babies (Beck, 2006). The leading cause of maternal death up to one year postpartum is suicide and the risk of suicide increases by 70% in women with PP. The prevalence of suicide in women with PP is 2 out of every 1000 and it has been noted that these women often result to more drastic, irreversible and extremely aggressive means such as self incineration and jumping from heights (Sit, Rothschild and Wisner, 2006). Conversely another study indicated that women without PP generally result to non-violent suicide such as overdosing. With regards to homicidal thoughts, studies have shown that 28%-35% of women hospitalised for PP reported delusions about their infant but only 9% had thoughts of infanticide (Sit, Rothschild and Wisner, 2006). Although PP is classified by the DSM-IV as a major form of depression, there is mounting evidence that suggests PP is an overt presentation of bipolar disorder after delivery. This can be seen in epidemiological studies where the prevalence of PP after childbirth is 72%-88% for mothers with bipolar disorder and 12% for mothers with schizophrenia (Sit, Rothschild and Wisner, 2006). Epidemiological studies have calculated the mean age of onset of PP to be 26.3 years, a time when most women have undergone their first or second childbirth (Sit, Rothschild and Wisner, 2006). | + | A more severe and rare form of PPD is Postpartum psychosis (PPP). Postpartum psychosis is believed to be a manifestation of bipolar disorder (Sit, Rothschild and Wisner, 2006). It is estimated to occur in one to two women per 1000 births within the first two to four weeks after childbirth. Unlike postpartum baby blues and postpartum depression, postpartum psychosis is a psychiatric emergency that requires immediate professional treatment due to severe symptoms such as hallucinations, paranoia, delusions and self-harming thoughts that could potentially result in suicide or infanticide (Sit, Rothschild and Wisner, 2006)(Beck, 2006). As a result women with postpartum psychosis must never be left alone, they must be under supervision 24hours of the day as they are a risk to themselves and their babies (Beck, 2006). The leading cause of maternal death up to one year postpartum is suicide and the risk of suicide increases by 70% in women with PPP. The prevalence of suicide in women with PPP is 2 out of every 1000 and it has been noted that these women often result to more drastic, irreversible and extremely aggressive means such as self incineration and jumping from heights (Sit, Rothschild and Wisner, 2006). Conversely another study indicated that women without PP generally result to non-violent suicide such as overdosing. With regards to homicidal thoughts, studies have shown that 28%-35% of women hospitalised for PPP reported delusions about their infant but only 9% had thoughts of infanticide (Sit, Rothschild and Wisner, 2006). Although PPP is classified by the DSM-IV as a major form of depression, there is mounting evidence that suggests PPP is an overt presentation of bipolar disorder after delivery. This can be seen in epidemiological studies where the prevalence of PPP after childbirth is 72%-88% for mothers with bipolar disorder and 12% for mothers with schizophrenia (Sit, Rothschild and Wisner, 2006). Epidemiological studies have calculated the mean age of onset of PP to be 26.3 years, a time when most women have undergone their first or second childbirth (Sit, Rothschild and Wisner, 2006). |
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| ==== Worldwide ==== | ==== Worldwide ==== | ||
| - | <box 29% round right| > {{ :worldwide_prevalence.png?300|}} </box| Figure 6: Prevalence of PPD in selected low-and-middle-income countries worldwide. Modified from Gelaye B et al. (2016). > | + | <box 29% round right| > {{ :worldwide_prevalence.png?300|}} </box| Figure 7: Prevalence of PPD in selected low-and-middle-income countries worldwide. Modified from Gelaye B et al. (2016). > |
| Based on a meta-analysis conducted by Gelaye B et al. (2016), the pooled prevalence of postpartum depression (PPD) in women from low-and-middle-income (LAMIC) countries worldwide is estimated to be 19%. The meta-analysis included 53 studies published between 1998 and 2015. The data collected from these studies represented 23 LAMIC countries and a total of 38,142 participants. Of the 53 studies, 7 studies were from Brazil, 6 from Turkey, 4 from India, 4 from Thailand, 4 from China, 3 from Mexico, 3 from Nigeria, 3 from Iran and the rest (1 or 2 studies) from other LAMICs (Armenia, Ghana, Jordan, Lebanon, Malaysia, Mongolia, Morocco, Nepal, Pakistan, Peru, South Africa, Tunisia, Uganda, Vietnam and Zimbabwe). Sample sizes ranged from 41 in Thailand to 13,360 in Ghana. | Based on a meta-analysis conducted by Gelaye B et al. (2016), the pooled prevalence of postpartum depression (PPD) in women from low-and-middle-income (LAMIC) countries worldwide is estimated to be 19%. The meta-analysis included 53 studies published between 1998 and 2015. The data collected from these studies represented 23 LAMIC countries and a total of 38,142 participants. Of the 53 studies, 7 studies were from Brazil, 6 from Turkey, 4 from India, 4 from Thailand, 4 from China, 3 from Mexico, 3 from Nigeria, 3 from Iran and the rest (1 or 2 studies) from other LAMICs (Armenia, Ghana, Jordan, Lebanon, Malaysia, Mongolia, Morocco, Nepal, Pakistan, Peru, South Africa, Tunisia, Uganda, Vietnam and Zimbabwe). Sample sizes ranged from 41 in Thailand to 13,360 in Ghana. | ||
| - | Figure 6 shows a subset of the studies analyzed and the associated prevalence of PPD (%), as well as the scale used to measure PPD. While there was significant heterogeneity observed between studies, the highest prevalence of PPD was seen in India (48.5%) and the lowest prevalence of PPD was observed in Ghana (3.8%). PPD was predominantly measured using the Edinburgh Postnatal Depression Scale (EPDS). The EPDS is a 10-item, self-reported scale that includes questions such as "I have felt scared or panicky for no good reason," "I look forward with enjoyment to things," and "The thought of harming myself has occurred to me." Other scales utilized to measure PPD included the Patient Health Questionnaire-9 (PHQ-9) and the Structured Clinical Interview for DSM-IV (SCID). | + | Figure 7 shows a subset of the studies analyzed and the associated prevalence of PPD (%), as well as the scale used to measure PPD. While there was significant heterogeneity observed between studies, the highest prevalence of PPD was seen in India (48.5%) and the lowest prevalence of PPD was observed in Ghana (3.8%). PPD was predominantly measured using the Edinburgh Postnatal Depression Scale (EPDS). The EPDS is a 10-item, self-reported scale that includes questions such as "I have felt scared or panicky for no good reason," "I look forward with enjoyment to things," and "The thought of harming myself has occurred to me." Other scales utilized to measure PPD included the Patient Health Questionnaire-9 (PHQ-9) and the Structured Clinical Interview for DSM-IV (SCID). |
| ==== Canada ==== | ==== Canada ==== | ||
| - | A study conducted by Lanes A et al. (2011) estimated the overall prevalence of minor and minor/major Postpartum Depressive Symptomatology (PPDS) in Canadian women to be 17.15%, with the highest prevalence of PPDS in the Territories (29.95%) and the lowest prevalence of PPDS in Prince Edward Island (10.89%; Figure 7). PPDS was measured using the EPSD, where a score of 0-9 indicated no risk of experiencing symptoms of PPD, a score of 10-12 indicated a minor/major risk, and a score of 13 or more indicated a major risk of experiencing PPD symptoms. | + | A study conducted by Lanes A et al. (2011) estimated the overall prevalence of minor and minor/major Postpartum Depressive Symptomatology (PPDS) in Canadian women to be 17.15%, with the highest prevalence of PPDS in the Territories (29.95%) and the lowest prevalence of PPDS in Prince Edward Island (10.89%; Figure 8). PPDS was measured using the EPSD, where a score of 0-9 indicated no risk of experiencing symptoms of PPD, a score of 10-12 indicated a minor/major risk, and a score of 13 or more indicated a major risk of experiencing PPD symptoms. |
| - | <box 39% round right| > {{::canada_prevalence.png?400|}} </box| Figure 7: Prevalence of PPD in Canadian women. Modified from Lanes A et al. (2011). > | + | <box 39% round right| > {{::canada_prevalence.png?400|}} </box| Figure 8: Prevalence of PPD in Canadian women. Modified from Lanes A et al. (2011). > |
| A total of 6,421 Canadian women from 10 provinces and 3 Territories were included in the study. These women had a live birth between 2005 and 2006 as well as previously completed the Maternity Experience Survey (MES), a nationwide survey conducted by Statistics Canada between 2006 and 2007 to assess pregnancy, delivery, and postnatal experiences of mothers and their children. | A total of 6,421 Canadian women from 10 provinces and 3 Territories were included in the study. These women had a live birth between 2005 and 2006 as well as previously completed the Maternity Experience Survey (MES), a nationwide survey conducted by Statistics Canada between 2006 and 2007 to assess pregnancy, delivery, and postnatal experiences of mothers and their children. | ||
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| The prevalence of PPD in the USA was calculated by Ko LY et al. (2017) using self-reported data collected from 27 US States participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is an ongoing, population-based surveillance system that collects state-specific data on maternal attitudes and experiences before, during, and after pregnancy (CDC, 2018). Questions are based on attitudes and feelings about a woman's most current pregnancy, maternal alcohol and tobacco consumption, physical abuse before and during pregnancy, infant health care, and mother's knowledge of pregnancy-related health issues, among other topics (CDC, 2018). | The prevalence of PPD in the USA was calculated by Ko LY et al. (2017) using self-reported data collected from 27 US States participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is an ongoing, population-based surveillance system that collects state-specific data on maternal attitudes and experiences before, during, and after pregnancy (CDC, 2018). Questions are based on attitudes and feelings about a woman's most current pregnancy, maternal alcohol and tobacco consumption, physical abuse before and during pregnancy, infant health care, and mother's knowledge of pregnancy-related health issues, among other topics (CDC, 2018). | ||
| - | The PRAMS data indicated an overall incidence of postpartum depressive symptoms (PDS) in 11.5% of women in 2012. In 13 of the states participating in PRAMS, there was a decline in PDS from 14.8% in 2004 to 9.8% in 2012 (Figure 8). PDS was found to be highest in mothers who had less than 12 years of education, were unmarried, were postpartum smokers, had greater than or equal to 3 stressful life events in a year before birth of the child, and had a child of abnormally low birthweight or that had to be admitted to the intensive care unit (ICU). | + | The PRAMS data indicated an overall incidence of postpartum depressive symptoms (PDS) in 11.5% of women in 2012. In 13 of the states participating in PRAMS, there was a decline in PDS from 14.8% in 2004 to 9.8% in 2012 (Figure 9). PDS was found to be highest in mothers who had less than 12 years of education, were unmarried, were postpartum smokers, had greater than or equal to 3 stressful life events in a year before birth of the child, and had a child of abnormally low birthweight or that had to be admitted to the intensive care unit (ICU). |
| - | <box 32% round right| > {{ ::usa_prevalence.png?330|}} </box| Figure 8: Prevalence of PPD in women from 23 and 13 US States. Modified from Ko LY et al. (2017).> | + | <box 32% round right| > {{ ::usa_prevalence.png?330|}} </box| Figure 9: Prevalence of PPD in women from 23 and 13 US States. Modified from Ko LY et al. (2017).> |
| ==== PPD in Men ==== | ==== PPD in Men ==== | ||
