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University of Pittsburgh Schools of the Health Sciences

Postpartum Depression is a Major Public Health Problem That Requires More Resources

JAMA Editorial Notes Childbearing Presents Unique Vulnerability for Psychiatric Illness, Making Effective Screening, Education and Treatment Essential

PITTSBURGH, December 5, 2006 — Childbearing is a potent event in the lives of women, a particularly vulnerable time for developing or exacerbating psychiatric illness, say University of Pittsburgh School of Medicine researchers in an editorial published in the Dec. 6 edition of the Journal of the American Medical Association (JAMA). The editorial, in response to a large Danish study of perinatal psychiatric episodes, calls for greater attention to the mental health of mothers and education, screening and treatment programs.

After giving birth, one in seven mothers will experience some form of depression that impairs their ability to function. Many of them will be undiagnosed and untreated. This creates a major public health problem, say leading experts from the University of Pittsburgh and University of California, San Diego.

“Postpartum depression not only affects the mother. It touches the father, other children in the family and most importantly, the newborn,” said Katherine L. Wisner, M.D., M.S., professor of psychiatry and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and an associate investigator at the Magee-Womens Research Institute. “Knowing what we do about the risks of postpartum depression, we must recognize our responsibility to address this illness through improved research and greater access to care and services.”

The Danish study, which is published in the same issue of the journal and authored by Birger Munk Olsen and colleagues, represents the first large-scale epidemiological study of psychiatric illness during childbearing to be completed in more than 20 years. The researchers found that women were at much higher risk of hospitalization for psychiatric conditions in the three-month period after birth when compared to women who were 12 months postpartum. The risks were greatest for those giving birth to their first child.

According to Dr. Wisner, other research has shown that postpartum depression disrupts the relationship between the mother and the infant, which can have short- and long-term adverse effects. Maternal depression can negatively impact a newborn’s mental and motor development and is associated with poor self-regulation, low self-esteem and behavior problems. Postpartum depression also has a dramatic impact on the mother’s ability to function, enjoy relationships, cope with the stresses, or appreciate the joys of parenthood.

Dr. Wisner notes that the United States has not, until recently, prioritized postpartum illness as a major public health concern. In fact, the Agency for Healthcare Research and Quality has reported that while much is known about the risks and vulnerabilities of the postpartum period, there is a significant lack of substantial high-quality research in this area.

Based on the recent study and past findings, Dr. Wisner recommends in the editorial that the United States take steps to implement a universal screening program, in which all women are screened between two- and 12-weeks postpartum. Those presenting with symptoms of a psychiatric disorder should be treated immediately after diagnosis, she says.

The State of New Jersey has been the first to address the problem on the governmental level by legislating that all women receive screening and education for postpartum depression; the law went into effect in October.

The University of Pittsburgh is conducting the first large-scale National Institute of Mental Health (NIMH)-funded trial of screening, treatment preference and depression care management methods. This study aims to evaluate screening methods and interventions for postpartum depression, and the researchers hope that the information gained through this study will be used to develop universal best practices for screening and treatment.

Other authors of the editorial include Christina Chambers, Ph.D., M.P.H., of the University of California, San Diego and Dorothy K.Y. Sit, M.D., of the University of Pittsburgh.

For more information about the University of Pittsburgh study or postpartum depression care at Women’s Behavioral HealthCARE of Western Psychiatric Institute and Clinic, call 1-800-436-2461 or 412-586-9072.

Women outside of the Pittsburgh area seeking more information or treatment should contact Postpartum Support International, http://www.postpartum.net/ , 1-800-944-4PPD.

Financial Disclosure

Dr. Wisner receives research funding from NIMH, the Stanley Medical Research Foundation, the state of Pennsylvania and Pfizer. She is on the speaker’s bureau for GlaxoSmithKline. Dr. Chambers receives research funding from the National Institute on Alcohol Abuse and Alcoholism, Abbott Laboratories, Sanofi Aventis, Sanofi Pasteur, Amgen Inc., Bristol-Myers Squibb, Sandoz Pharmaceuticals, Teva Pharmaceuticals USA, Apotex Inc., Barr Laboratories, and Kali Laboratories for research not involving psychotherapeutic agents. She also receives research funding from the State of California and is a consultant for Cephalon Inc. Dr. Sit has no pharmaceutical funding for research or speaking engagements. She has funding for research through NARSAD and the University of Pittsburgh.

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