The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care


      Inconsistent diagnostic criteria fail to delineate guidelines for postpartum depression surveillance. This study evaluates the validity of commonly accepted postpartum onset criteria.

      Study design

      Consecutive referrals to the Emory Women's Mental Health Program for evaluation of postpartum depression fulfilling criteria for major depression and taking no psychotropic medication were included. Diagnostic interview, demographics, depression scales, and the time of illness onset were obtained. Descriptive analysis was conducted for 3 participant groups: pregnancy onset, early postpartum onset within 6 weeks of delivery, and late postpartum onset.


      Among participants, 11.5% reported prenatal onset, 22.0% late postpartum onset, and 66.5% early postpartum symptom onset. Those reporting pregnancy onset were more likely to be unmarried, and those with a late postpartum onset were less likely to report a past history of postpartum depression.


      The perinatal vulnerability to depression begins before delivery and extends beyond 6 weeks postpartum. Depression surveillance is therefore warranted during prenatal visits, at the postnatal check up, and at pediatric visits during the initial 6 months of the first postnatal year.

      Key words

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        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders.
        4th ed. American Psychiatric Association Press, Washington, DC1994
        • World Health Organization
        The international statistical classification of diseases and related health problems.
        10th revision. World Health Organization, Geneva, Switzerland1992
        • Brockington I.F.
        • Cernik K.F.
        • Schofield E.M.
        • Downing A.R.
        • Francis A.F.
        • Keelan C.
        Puerperal psychosis: phenomena and diagnosis.
        Arch Gen Psychiatry. 1981; 38: 829-833
        • Miller L.J.
        Postpartum depression.
        JAMA. 2002; 287: 762-765
        • Purdy D.
        • Frank E.
        Should post-partum mood disorders be given a more prominent or distinct place in the DSM-IV?.
        Depress Anxiety. 1993; 1: 59-79
        • O'Hara M.W.
        • Neunaber D.J.
        • Zekoski E.M.
        Prospective study of postpartum depression: prevalence, course, and predictive factors.
        J Abnorm Psychol. 1984; 93: 158-171
        • O'Hara M.W.
        Social support, life events and depression during pregnancy and the puerperium.
        Arch Gen Psychiatry. 1986; 43: 569-573
        • Buesching D.P.
        • Glasser M.L.
        • Frate D.A.
        Progression of depression in the prenatal and postpartum periods.
        Womens Health. 1986; 11: 61-78
        • Watson J.P.
        • Elliott S.A.
        • Rugg A.J.
        • Brough D.I.
        Psychiatric disorder in pregnancy and the first postnatal year.
        Br J Psychiatry. 1984; 144: 453-462
        • Gotlib I.H.
        • Whiffen V.E.
        • Mount J.H.
        • Milne K.
        • Cordy N.I.
        Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum.
        J Consult Clin Psychol. 1989; 57: 269-274
        • Evans J.
        • Heron J.
        • Francomb H.
        • Oke S.
        • Golding J.
        Cohort study of depressed mood during pregnancy and after childbirth.
        BMJ. 2001; 323: 257-260
        • Cox J.L.
        • Hoklen J.M.
        • Sagovsky R.
        Development of the 10-item Edinburgh Postnatal Depression Scale.
        Br J Psychiatry. 1987; 150: 782-786
        • Beck A.T.
        • Ward C.H.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Martin C.J.
        • Brown G.W.
        • Goldberg D.P.
        • Brockington I.F.
        Psychosocial stress and puerperal depression.
        J Affect Disord. 1989; 16: 283-293
        • Kitamura T.
        • Sugawara M.
        • Sugawara K.
        • Toda M.A.
        • Shima S.
        Psychosocial study of depression in early pregnancy.
        Br J Psychiatry. 1996; 168: 732-738
        • Weetman A.P.
        Prediction of post-partum thyroiditis.
        Clin Endocrinol. 1994; 41: 7-8
        • Lazarus J.H.
        Prediction of postpartum thyroiditis.
        Eur J Endocrinol. 1998; 139: 12-13
        • Muller A.F.
        • Drexhage H.A.
        • Berghout A.
        Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care.
        Endocr Rev. 2001; 22: 605-630
        • Newport D.J.
        • Wilcox M.M.
        • Stowe Z.N.
        Maternal depression: a child's first adverse life event.
        Semin Clin Neuropsychiatry. 2002; 7: 113-119
        • Newport D.J.
        • Stowe Z.N.
        • Nemeroff C.B.
        Parental depression: animal models of an adverse life event.
        Am J Psychiatry. 2002; 159: 1265-1283
        • Kumar R.
        • Robson K.M.
        A prospective study of emotional disorders in childbearing women.
        Br J Psychiatry. 1984; 144: 35-47
        • Hobfoll S.E.
        • Ritter C.
        • Lavin J.
        • Hulsizer M.R.
        • Cameron R.P.
        Depression prevalence and incidence among inner-city pregnant and postpartum women.
        J Consult Clin Psychol. 1995; 63: 445-453
        • Kelly R.H.
        • Zatzick D.F.
        • Anders T.F.
        The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics.
        Am J Psychiatry. 2001; 158: 213-219
        • Roy A.
        • Cole K.
        • Goldman Z.
        • Barris M.
        Fluoxetine treatment of postpartum depression.
        Am J Psychiatry. 1993; 150: 1273
        • Stuart S.
        • O'Hara M.W.
        Treatment of postpartum depression with interpersonal psychotherapy.
        Arch Gen Psychiatry. 1995; 52: 75-76
        • O'Hara M.W.
        • Stuart S.
        • Gorman L.L.
        • Wenzel A.
        Efficacy of interpersonal psychotherapy for postpartum depression.
        Arch Gen Psychiatry. 2000; 57: 1039-1045
        • Ahokas A.
        • Kaukoranta J.
        • Wahlbeck K.
        • Aito M.
        Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17β-estradiol: a preliminary study.
        J Clin Psychiatry. 2001; 62: 332-336
        • Cohen L.S.
        • Viguera A.C.
        • Bouffard S.M.
        • Nonacs R.M.
        • Morabito C.
        • Collins M.H.
        • Ablon J.S.
        Venlafaxine in the treatment of postpartum depression.
        J Clin Psychiatry. 2001; 62: 592-596
        • Suri R.
        • Burt V.K.
        • Altshuler L.L.
        • Zuckerbrow-Miller J.
        • Fairbanks L.
        Fluvoxamine for postpartum depression.
        Am J Psychiatry. 2001; 158: 1739-1740
        • Klier C.M.
        • Muzik M.
        • Rosenblum K.L.
        • Lenz G.
        Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression.
        J Psychother Pract Res. 2001; 10: 124-131
        • Newport D.J.
        • Hostetter A.
        • Arnold A.
        • Stowe Z.N.
        The treatment of postpartum depression: minimizing infant exposures.
        J Clin Psychiatry. 2002; 63: 31-44
        • Georgiopoulos A.M.
        • Bryan T.L.
        • Wollan P.
        • Yawn B.P.
        Routine screening for postpartum depression.
        J Fam Pract. 2001; 50: 117-122
        • Stowe Z.N.
        • Calhoun K.
        • Ramsey C.
        • Sadek N.
        • Newport D.J.
        Mood disorders during pregnancy and lactation: defining issues of exposure and treatment.
        CNS Spectr. 2001; 6: 150-166