Postnatal depression
BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4500 (Published 14 August 2014) Cite this as: BMJ 2014;349:g4500
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Breast feeding is seen by many mothers as a test of motherhood.
This mother had 6 weeks of difficulties with breast feeding
The expertise in breast feeding no longer exists since the early discharge of mothers
How often is difficulty with breast feeding in the mix of mothers with baby blues and post-natal depression?
Competing interests: No competing interests
Jones and Shakespeare highlight the ease with which postnatal depression can be missed but fail to emphasise the long term risks to children from this condition. That it "might also have detrimental effects on the baby ..." is true, but what about the later development of the child and adolescent? This paper would have been more useful had it included any reference to the major work in the long term effects of postnatal depression in both mothers and fathers (1), that has been going on for decades.
Besides the well established effects of prenatal stress (2) on child development, there is good evidence to show effects of postnatal depression on intellectual development and self regulation, particularly on boys (3, 4, 5), and on mood right into the mid-teens (6).
Postnatal depression is a psychosocial syndrome commoner in women who are emotionally unsupported or intimidated (7). Pregnancy and birth present unique opportunities, but also huge organisational challenges (8), for multiagency preventive intervention.
1. Ramchandani PG, Domoney J, Sethna V, Psychogiou L, Vlachos H, Murray L. (2013) Do early father-infant interactions predict the onset of externalising behaviours in young children? Findings from a longitudinal cohort study. J Child Psychol Psychiatry 2013: 54(1):56-64. doi: 10.1111/j.1469-7610.2012.02583.x.
2. Bergman K1, Sarkar P, Glover V, O'Connor TG. Maternal prenatal cortisol and infant cognitive development: moderation by infant-mother attachment. Biol Psychiatry 2010; 1;67(11):1026-32. doi: 10.1016/j.biopsych.2010.01.002.
3. Morrell, J. and Murray, L. Parenting and the development of conduct disorder and hyperactive symptoms in childhood: a prospective longitudinal study from 2 months to 8 years. Journal of Child Psychology and Psychiatry 2003; 44: 489–508. doi: 10.1111/1469-7610.t01-1-00139
4. Hay, D. F., Pawlby, S., Sharp, D., Asten, P., Mills, A. and Kumar, R. Intellectual Problems Shown by 11-year-old Children Whose Mothers Had Postnatal Depression. Journal of Child Psychology and Psychiatry 2011; 42: 871–889. doi: 10.1111/1469-7610.00784
5. Murray, L., Arteche, A., Fearon, P., Halligan, S., Croudace, T. and Cooper, P. The effects of maternal postnatal depression and child sex on academic performance at age 16 years: a developmental approach. Journal of Child Psychology and Psychiatry 2010; 51: 1150–1159. doi: 10.1111/j.1469-7610.2010.02259.x
6. Murray L, Arteche A, Fearon P, Halligan S, Goodyer I, Cooper P. Maternal Postnatal Depression and the Development of Depression in Offspring Up to 16 Years of Age. Journal of the American Academy of Child & Adolescent Psychiatry 2011; 50 (5): 460 doi: 10.1016/j.jaac.2011.02.001
7. Ludermir AB, Lewis G, Valongueiro SA, de Araújo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet 2010; 11;376(9744):903-10. doi: 10.1016/S0140-6736(10)60887-2.
8. Myors, K. A., Schmied, V., Johnson, M. and Cleary, M., Collaboration and integrated services for perinatal mental health: an integrative review. Child and Adolescent Mental Health 2013; 18: 1–10. doi: 10.1111/j.1475-3588.2011.00639.x
Competing interests: No competing interests
Re: Postnatal depression: may present as back pain
I welcome very much the review by Jones and Shakespeare on postnatal depression [1].
During a study on chronic postpartum spinal pain at Northwick Park Hospital, 95 women were seen within a year of delivery, all of whom noted back pain on a postal questionnaire sent out as part of follow-up of a study on epidural analgesia [2]. It was found that the modified Zung depression score was a significant predictor of the Roland disability score for back pain [3].
Of greater note, however, was the fact that three (3.2%) patients were excluded from the study on back pain because of clinical depression (unpublished data).
All patients with persistent postnatal back pain should be screened for depression as suggested by Jones and Shakespeare [1].
Reference List
(1) Jones I, Shakespeare J. Postnatal depression. BMJ (Clinical research ed ) 2014; 349:g4500.
(2) Loughnan BA, Carli F, Romney M, Dore CJ, Gordon H. A randomised controlled comparison of epidural Bupivacaine vs Pethidine for analgesia in labour. Br J Anaesth 2000; 84(6):715-719.
(3) Frank AO, Sharma V, Romney M, Frank A~D, McAuley JH, De Souza LH and Loughnan B. Hypermobility and postpartum chronic spinal pain. Proceedings of the Third Congress of the European Federation of IASP Chapters, Nice. Seattle: International Association for the Study of Pain; 2000.
Competing interests: No competing interests