Exploring the heterogeneity in clinical presentation and functional impairment of postpartum depression

Abstract

Objective: Examine the spectrum of postpartum psychiatric conditions with the aim to evaluate the current use of a postpartum onset specifier. Background: The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) uses an onset specifier to categorise a limited number of psychiatric diagnoses as postpartum onset. Diagnoses and clinical symptomatology, however, may be more complex than what the DSM-IV-TR allows. Methods: A total of 59 women aged 19–41 years were recruited 3–6 months postpartum. Women completed questionnaires and those scoring possibly depressed, identified by scoring at least 10 (30 maximum) on the Edinburgh Postnatal Depression Scale, participated in semi-structured psychiatric evaluations. Degree of functional impairment was rated on a three-point scale. Results: Possibly depressed women did not differ from healthy controls on several background characteristics. Postpartum diagnoses were heterogeneous; only 46% of possibly depressed women received a diagnosis of major depression. Other diagnoses included depressive disorder not otherwise specified, adjustment disorder, anxiety disorder not otherwise specified, alcohol dependence, and two women did not qualify for a diagnosis. Functional impairment did not differ across diagnoses. A diathesis-stress perspective aided understanding of the clinical expression of psychopathology and creating clinical case formulations. Conclusions: The limited application of a postpartum onset specifier is unsatisfactory. Unless the diverse range of postpartum disorders is properly acknowledged by considering a diathesis–stress perspective and allowing for an onset specifier, the care of women experiencing psychological distress during the postpartum period may have reduced effectiveness and future research will be hindered.

Keywords:

• Postpartum depression
• postpartum care
• psychosocial factors
• interviews
• mothers

Acknowledgements

The current study was supported by grants from the National Institute of Mental Health (MH082925, PI: J. Heiman and H. Rupp) and (MH094011, PI: Q. Class). We would like to thank all women that participated as well as Christine White for recruitment assistance.