Depressed Ante- and
Postpartum Patients
DSM-IV recognizes childbirth as a possible precipitant of major depressive episodes, using the specifier ". . . with postpartum onset" if the episode begins within four weeks of delivery ( American Psychiatric Association, 1994). There is no separate classification for depression occurring during pregnancy. IPT has been adapted for depressed women during pregnancy and the postpartum period, but not to other postpartum disturbances such as bipolar disorder or brief psychotic disorder.
Although conventional wisdom deems pregnancy a time of calm expectation and happiness, about 10 percent of pregnant women develop a major or minor depressive episode ( Spinelli, 1997a). Predisposing factors include a personal or family history of depression; marital problems; single parenthood; a large number of children; young age; and low education. Depressed pregnant women are at increased risk for poor health habits, including drug, alcohol, and nicotine use, and failure to obtain adequate prenatal care. Pregnant depressed women have an increased risk after childbirth of child abuse and neglect and postpartum depression. Numerous studies have shown that the offspring of depressed mothers face high risk for onset of prepubertal anxiety disorders, major depression in adolescence, substance abuse in late adolescence and young adulthood, as well as greater medical and school problems ( Weissman et al., 1997; Wickramaratne and Weissman, 1999; Kramer et al., 1998). These problems persist over generations.
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