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First published online September 15, 2009

Postnatal depression: A global public health perspective

Abstract

The aim of this paper is to discuss whether or not postnatal depression is a global public health concern. Public health is the study of the morbidity, mortality and the cause and course of disease, at a population rather than an individual level. Public health is also concerned with examining factors that cause health inequalities. Postnatal depression is a mental and emotional condition that can affect women during the first postnatal year. Since the effects of postnatal depression are known to go beyond the mother in that it also affects the partner and the child, it can be deemed a public health problem. Additionally, severe postnatal depression can lead to infanticide as well as maternal death, often by suicide. Furthermore, evidence demonstrates that all countries are faced with the challenge of postnatal depression, but low- to middle-income countries face the greatest burden. The literature revealed various treatment options for this complex condition. However, it also uncovered that not all women are assessed for postnatal depression, nor do all women receive treatment. The emerging picture is that postnatal depression is indeed a public health problem, particularly as the incidence is much higher than the quoted rate of 10%—15%. This paper recommends direction for public health-orientated perinatal mental health research and suggests that service providers should consider the routine assessment of all postnatal women.

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References

Aiken C. Surviving Postnatal Depression: At Home, No One Hears You Scream. London: Jessica Kingsley Publishers, 2000
Leahy-Warren P., McCauley C., McCarthy G. Postnatal depression: Prevalence, mothers’ perspectives, and treatments. Archives of Psychiatric Nursing 2007; 21(2): 91-100
Hanley J. The emotional well-being of Bangladeshi mothers during the postnatal period . Community Practitioner 2007; May 80(5): 34-37
Almond P. A Study of Equity within Health Visiting Postnatal Depression Policy and Services . University of Southampton: unpublished PhD thesis, 2008
Lewis G. Saving Mothers ’ Lives: Reviewing Maternal Deaths to make Motherhood Safer 2003-2005 . London: Royal College of Obstetricians and Gynaecologists, 2007
Pritchard DB, Harris B. Aspects of perinatal psychiatric illness. British Journal of Psychiatry 1996 ; 169: 555-562
Henshaw C. Mood disturbances in the early puerperium: A review. Archive Women Mental Health 2003; 6 (Supplement 2): s33-s42
Cox JL, Murray D., Chapman G. A controlled study of the onset, duration and prevalence of postnatal depression . British Journal of Psychiatry 1993; 163: 27-31
Oates M. Perinatal Mental Health Services. London: Royal College of Psychiatrists, 2000
American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Press, 2000
Cox J. Postnatal mental disorder: Towards ICD-11. World Psychiatry 2004; 3: 96-97
Najman JM, Andersen MJ, Bor W., O’Callaghan MJ, Williams GM Postnatal depression - myth and reality: Maternal depression before and after the birth of a child. Social Psychiatry Epidemiology 2000; 35(1): 19-27
Cox JL, Holden JM Perinatal Mental Health: A Guide to the Edinburgh Postnatal Depression Scale . London: Gaskell, 2003
Pope S., Watts J., Evans S., McDonald S., Henderson J. Postnatal Depression: A Systematic Review of Published Scientific Literature to 1999. Canberra: National Health and Medical Research Council, 2000
Milgrom J., Gemmill AW, Bilszta JL, Hayes B., Barnett B., Brooks J., Ericksen J., Ellwood D., Buist A. Antenatal risk factors for postnatal depression: A large prospective study . Journal of Affective Disorders 2008 ; 108: 147-157
Irfan N., Badar A. Determinants and pattern of postpartum psychological disorders in Hazara division of Pakistan. Journal of Ayub Medical College Abbottabad 2003; 15(3): 19-23
Rahman A., Iqbal Z., Harrington R. Life events, social support and depression in childbirth: Perspectives from a rural community in the developing world. Psychological Medicine 2003; 33: 1161-1167
Patel V., Rodriques M., DeSouza N. Gender, poverty, and postnatal depression: A study of mothers in Goa, India . American Journal Psychiatry 2002; 159: 43-47
Husain N., Beve I., Husain M., Chaudhry B., Atif N., Rahman A. Prevalence and social correlates of postnatal depression in a low-income country . Archives of Women’s Mental Health 2006; 9: 197-202
Lee DTS, Alexander SK, Yip K., Tony Y., Leung S., Chung TKH. Ethnomethodology of postnatal depression: Prospective multivariate study of sociocultural risk factors in a Chinese population in Hong Kong. British Journal of Psychiatry 2004; 184: 34-40
Kumar R. Postnatal mental illness: A transcultural perspective. Social Psychiatry and Psychiatric Epidemiology 1994; 29(6): 250-264
O’Hara MW, Swain AM Rates of risk and postpartum depression - A meta-analysis. International Review of Psychiatry 1996; 8: 37-54
Warner R., Appleby L., Whitton A., Faragher B. Demographic and obstetric risk factors for postnatal psychiatric morbidity . British Journal of Psychiatry 1996; 168(5): 607-611
Brockington IF Disorders specific to the puerperium. International Journal of Mental Health 1996; 21(2): 41-52
Neiland MNS, Roger D. Symptoms of postpartum and non-postpartum samples: Implications for postnatal depression. Journal of Reproductive and Infant Psychology 1997; 15: 31-42
Murray L., Sinclair D., Cooper P., Ducournau P., Turner P., Stein A. The socioemotional development of five-year-old children of postnatally depressed mothers. Journal of Child Psychology and Psychiatry 1999; 40(8): 1259-1271
Boath EH, Henshaw C. The treatment of postnatal depression: A comprehensive review of the literature . Journal of Reproductive and Infant Psychology 2001; 19(3): 215-248
Kendell RE, Chalmers L., Platz C. The epidemiology of puerperal psychosis. British Journal of Psychiatry 1987; 150: 662-673
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 1987; 150: 782-786
O’Hara M. Postpartum ‘blues’, depression and psychosis: A review. Journal of Obstetrics and Gynaecology Supplementary 1987; 7(205): 227
Evans J., Heron J., Francomb H., Oke S., Golding J. Cohort study of depressed mood during pregnancy and after childbirth . British Medical Journal 2001; 323: 257-260
Dietz PM, William SB, Callaghan WM, Bachman DJ, Whitlock EP, Hornbrook MC Clinically identified maternal depression before, during and after pregancies ending in live births. American Journal of Psychiatry 2007; 164: 1515-1520
Kok LP, Chan PS, Ratnam SS Postnatal depression in Singapore women. Singapore Medical Journal 1994; 35(1): 33-35
Areias ME, Kumar R., Barros H., Figueiredo E. Comparative incidence of depression in women and men during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers. British Journal of Psychiatry 1996; 169(1): 30-35
Kit LK, Janet G., Jegasothy R. Incidence of postnatal depression in Malaysian women. Journal of Obstetric Gynaecological Research 1997; 23(1): 85-89
Ghubash R., Abou-Saleh MT, Daradkeh TK The validity of the Arabic Edinburgh Postnatal Depression Scale. Social Psychiatry and Psychiatric Epidemiology 1997 ; 32(8): 474-476
Barnett B., Matthey S., Gyaneshwar R. Screening for postnatal depression in women of non-English speaking background . Archive of Women’s Mental Health 1999 ; 2: 67-74
Clifford C., Day A., Cox J., Werret J. A cross-cultural analysis of the use of the Edinburgh Postnatal Depression Scale (EPDS) in health visiting practice. Journal of Advanced Nursing 1999; 30(3): 655-664
Yamashita H., Yoshida K., Nakano H., Tashiro N. Postnatal depression in Japanese women. Detecting the early onset of postnatal depression by closely monitoring the postpartum mood. Journal of Affective Disorder 2000; 58(2): 145-154
Yoshida K., Yamashita H., Ueda M., Tashiro N. Postnatal depression in Japanese mothers and the reconsideration of "Satogaeribunben ". Paediatric International 2001; 43(2): 189-193
Templeton L., Velleman R., Persaud A., Milner P. The experiences of postnatal depression in women from black and minority ethnic communities in Wiltshire, UK. Ethnicity and Health 2003 ; 8(3): 207-221
Edge D., Baker D., Rogers A. Perinatal depression among black Caribbean women. Health and Social Care in the Community 2004; 12(5): 430-434
Onozawa K., Kumar R., Adams D., Dore C., Glover V. High EPDS scores in women from ethnic minorities living in London . Archives of Women’s Mental Health 2003; 6(2): 51-55
Rahman A., Iqbal Z., Harrington R. Social environment and depression among pregnant women in urban areas of Pakistan: Importance of social relations. Social Science and Medicine 2003; 63: 1466-1476
Fisher JRW, Morrow MM, Nhu Ngoc NT, Hoang Anh, LT Prevalence, nature, severity and correlates of postpartum depressive symptomatology in Ho Chi Minh City Vietnam. BJOG: An International Journal of Obstetrics and Gynaecology 2004; 111: 1353-1360
Edwards GD, Shinfuku N., Gittelman M., Ghozali EW, Haniman F., Wibisono S., et al. Postnatal depression in Surabaya, Indonesia. International Journal of Mental Health 2006; 35(1): 62-74
Huang YC, Mathers NJ Postnatal and the experience of south Asian marriage migrant women in Taiwan: Survey and semi-structured interview study. International Journal of Nursing Studies 2008; 45: 924-931
Halbreich U., Karkun S. Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. Journal of Affective Disorders 2006; 91(2-3): 97-111
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 1987; 150: 782-786
Murray L., Cooper PJ, Stein A. Postnatal depression and infant development. British Medical Journal 1991; 302(6783): 978-979
Cooper PJ, Murray L (eds). Postpartum Depression and Child Development . New York: The Guildford Press, 1997
Ramchandani P., Stein A., Evans J., O’Connor TG Paternal depression in the postnatal period and child development: A prospective population study . Lancet 2005; 365: 2210-2205
Harpham T., Huttly S., DeSilva MJ, Abramsky T. Maternal mental health and child nutritional status in four developing countries . Journal of Epidemiological and Community Health 2005; 59: 1060-1064
Rahman A., Bunn J., Lovel H., Creed F. Maternal depression increases infant risk of diarrhoeal illness: A cohort study. Archives of Diseases in Children 2007 ; 92: 24-28
Stewart RC Maternal depression and infant growth - A review of recent evidence . Maternal and Child Nutrition 2007; 3(2): 94-107
Baker-Henningham H., Powell C., Walker S., Grantham-McGregor S. Mothers of undernourished Jamaican children have poorer psychological functioning and this is associated with stimulation provided in the home. European Journal of Clinical Nutrition 2003; 57: 786-792
Carro M., Grant K., Gotlib I. Postpartum depression and child development: An investigation of mothers and fathers as sources of risk and resilience. Development of Psychopathology 1993; 5: 567-579
Zelkowitz P., Milet TH Screening for post-partum depression in a community sample. Canadian Journal of Psychiatry 1995; 40(2): 80-86
Webster A. The forgotten father: The effect on men when partners have PND. Community Practitioner 2002; 75(10): 390-393
Munk-Olsen T., Laurenson MT, Pedersen CB New parents and mental disorders: A population-based register study. Journal of American Medical Association 2006; 296(21): 2582-2589
Lewis G. Why Mothers Die 2000-2002. Confidential Enquiry in Maternal and Child Deaths . London: Royal College of Obstetricians and Gynaecologists, 2004
Lewis G. Why Mothers Die 1997-1999. Confidential Enquiry in Maternal Deaths . London: Royal College of Obstetricians and Gynaecologists, 2001
Boath EH, Henshaw C. The treatment of postnatal depression: A comprehensive review of the literature . Journal of Reproductive and Infant Psychology 2001; 19(3): 215-248
National Institute for Clinical Excellence. Antenatal and Postnatal Health: Clinical Management and Service Guidelines. London: HMSO, 2007
Department of Health. Improving Access to Psychological Therapies: Implementation Plan: National Guidelines for Regional Delivery and Contact. London: Department of Health, 2008.
Appleby L., Warner R., Whitton A., Farragher B. A controlled study of Fluoxetine and cognitive behavioural counselling in the treatment of postnatal depression. British Medical Journal 1997; 314: 932-936
O’Hara M., Stuart S., Gorman L., Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry 2000; 57: 1039-1043
Bledsoe S., Grote NK Treating depression during pregnancy and the postpartum: A preliminary meta-analysis . Research on Social Work Practice 2006; 16(2): 109-120
Milgrom J., Negri LM, Gemmill AW, McNeil M., Martin PR A randomized controlled trial of psychological interventions for postnatal depression. British Journal of Clinical Psychology 2005; 44: 429-542
Dennis CL, Hodnett ED Psychosocial and psychological interventions for treating postpartum depression . Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No. CD006116. 14651858.CD006116.pub2
Rahman A., Malik A., Sikander S., Roberts C., Creed F. Cognitive behaviour therapy-based interventions by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomized controlled trial. Lancet 2008; 372: 902-909
Rojas G., Fritsch R., Solis J., Jadresic J., Castillo C., Gonzalez M., Guajardo V., Lewis G., Peters TJ, Araya R. Treatment of postnatal depression in low-income mothers in primary care clinics in Santiago, Chile: A randomized control trial. Lancet 2007; 370(9599): 1629-1637
Holden JM, Sagovsky R., Cox JL Counselling in a general practice setting: Controlled study of health visitor intervention in treatment of postnatal depression. British Medical Journal 1989; 298(6668): 223-226
Gerrard J., Holden JM, Elliot SA, McKenzie P., McKenzie J., Cox JL A trainer’s perspective of an innovative programme teaching health visitors about the detection, treatment and prevention of postnatal depression. Journal of Advanced Nursing 1993; 18(11): 1825-1832
Seeley S., Murray L., Cooper P. Postnatal depression: The outcome for mothers and babies of health visitor intervention. Health Visitor 1996; 69(135): 138
Morrell CJ, Slade P., Warner R., Paley G., Dixon S., Walters SJ et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: Pragmatic cluster randomized trial in primary care. BMJ 2009; 338: a3045
Thurtle V. First-time mother’s perception of motherhood and PND. Community Practitioner 2003; 76(7): 261-265
Edge D., Baker D., Rogers A. Perinatal depression among black Caribbean women. Health and Social Care in the Community 2004; 12(5): 430-434
Almond P., Patel A., Davis H. Postnatal Depression: An Audit of Mothers’ and Health Visitors’ Perspectives. Welwyn Garden City: East Herts Clinical Audit Department, QE11 Hospital, 1995
Morgan M., Matthey S., Barnett B., Richardson C. A group programme for postnatally depressed women and their partners . Journal of Advanced Nursing 1997; 26: 913-920
Brugha T., Sharp H., Cooper A., Weisender C., Britto D., Shinkwin R., et al. The Leicester 500 project. Social support and the development of postnatal depressive symptoms. A prospective cohort survey. Psychological Medicine 1998 ; 28: 63-79
Eastwood P. Promoting peer group support with postnatally depressed women. Health Visitor 1995; 68(4): 148-150
Romain S., Jones A., Watts T. Facilitating peer group support. Health Visitor 1995; 68(4): 153
Pitts F. Comrades in adversity: The group approach. Health Visitor 1995; 68(4): 144-145
Lovell K., Richards D. Multiple Access Points and Levels of Entry (MAPLE): Ensuring choice, accessibility and equity for CBT services. Behavioural and Cognitive Psychotherapy 2000; 28: 379-391
Bebbington P., Brugha T., Meltzer H. Neurotic disorders and the receipt of psychiatric treatment. Psychological Medicine 2000; 30: 1369-1376
Shakespeare J. Health visitors screening for PND using the EPDS: A process study. Community Practitioner 2002; 75(10): 381-384
Scottish Intercollegiate Guidelines Network. Review of SIGN Guideline 60. Edinburgh: Scottish Intercollegiate Guidelines Network, 2005
Buist AE, Barnett BEW, Milgrom J., Pope S., Condon JT, Ellwood DA et al. To screen or not to screen? - That is the question in perinatal depression. SO Medical Journal of Australia 2002; 177 (Supplement 7): s101-s105

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Article first published online: September 15, 2009
Issue published: September 2009

Keywords

  1. epidemiology
  2. literature review
  3. postnatal depression
  4. global public health
  5. inequalities

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PubMed: 19788165

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Affiliations

Palo Almond, PhD, MSc, PGdipEd, PGdipAHCP, BSc Hons
University of Southampton, School of Health Sciences, Building 67, University Road, Highfield, Southampton, SO17 1BJ, [email protected]

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