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Postnatal depression

Although the rate of perinatal mortalityhas fallen greatly this century, the level ofmaternal psychiatric morbidity in the peri-natal period is essentially the same as it

was 100 years ago. Attempts to reduce thisrate were discussed at the annual confer-ence of the Marce Society, an interna-tional group for the understanding,prevention, and treatment of mental ill-

ness related to child-bearing, held earlierthis month in Eindhoven, Netherlands.Mothers in the postnatal period stand a

10-15% risk of developing depression.Some of these mothers have a history ofdepressive illness but for around 5% this isthe first episode. Up to 50% of all cases goundetected. The Edinburgh Postnatal

Depression Scale (EPDS) is a simplescreening questionnaire, now available in12 different languages. Speakers at the

meeting described the usefulness of theEPDS as the first stage in a two-partscreening procedure in community sam-ples in Scandinavia, the Netherlands,Australia, and the UK.

Intervention studies from Sweden andthe United States indicate the value of ’.

identifying cases and offering treatment inthe form of regular home visits and coun-selling by child health nurses (Sweden) or

public health nurses (the US) to speed upmothers’ rate of recovery. In a study fromCambridge, a specialist therapist provid-ing specific treatment such as cognitivebehavioural therapy (CBT), brief dynamicpsychotherapy, or counselling proved nomore effective than health visitors trainedto offer the same therapies. Mothersstated a preference for CBT, delivered ei-ther by a specialist or by a health visitor.

Postnatal depression affects not only themother but also the infant, because it im-pairs the mother-infant relationship.American studies in the 1980s looked atthe infants of selected groups of women, 1such as single, black, or teenage mothers, 1with postnatal depression. By 4-6 months 1there were severe impairments in mother-infant interaction, with evidence of inse- 1cure attachments and delayed cognitivedevelopment. The team at the Winnicott 1Research Unit in Cambridge have beentesting the reliability of these findings in 1community samples and over a greater iage-range of infants. Although serious be-havioural disturbance in preschool years is 1not a significant consequence of maternalpostnatal depression, the researchers re- 1ported that at 18 months there was im- 1pairment of the child’s cognitive 1development and the quality of the

mother-infant relationship, especially 1among boys. Research on an inner city 1sample from the Institute of Psychiatry, 1London, found a 12-point deficit on theMcCarthy IQ scale in children at 4 years, 1with boys scoring more poorly than girls 1and being at higher risk of behavioural

problems. jDutch researchers propose a theory of

intergenerational transmission of infant-attachment behaviour, the mother draw- iing on her current perspective of hermother in shaping her child’s emotionalattachment behaviour and development.Detection and treatment of maternal imood disorders in the mother may be im-

proving but the bigger issues of breakingintergenerational transmission of dysfunc-tional behaviour and improving the out-come for the child remain a challenge.

Rosalind Ramsay

Thin-layer ozonography

To those holidaying on a Spanish costathe Antarctic seems heat and light years away. Translating ozone measurementsinto health education was always going tobe difficult, and the persistence of doubtin some scientists has not helped. Fouryears of continuous daily data from ’,Toronto-almost four years, for the

instrument was sent to Hawaii one win-ter-seem persuasive.

Kerr and McElroy’ report measure-

ments of ozone and of total radiation at324 and at 300 nm in the ultraviolet B. In

fact their instrument records every 0-5 nmfrom 290 to 325 nm. The stastistical

trend was down for total ozone (by 4-1%per year for winters and 1-8% for sum-

mers), more or less stable for UV-B at

324 nm, and up by 35% (winters) and6-7% (summers) for UV-B at 300 nm.

These two wavelengths represent the low-er and upper extremes of the absorptionspectrum of ozone, and the flatness of the

324 nm line discounts the argument that clouds and pollution are responsible for ozone’s decine. Close inspection of thegraph reveals that the upsurge in poten-tially hazardous LJV-B is all due to the last six consecutive values in the 1992/93 win-

ter; fluxes above 20 mj m-2 nm-1 in Toronto are more like summer expo- sures than winter ones. The biological consequences of ozone

losses tend to be out of proportion to the losses themselves Experts rate these data from the Canadian Atmospheric Environ- ment Service as very reliable.’ They may not make Toronto a skin-cancer capitalbut concern will be fuelled.

David Sharp

1 Kerr JB, McElroy CT. Evidence for largeupward trends of ultraviolet-B radiationlinked to ozone depletion. Science 1993; 262:1032-34.

2 Lloyd SA. Stratospheric ozone depletion.Lancet 1993; 342: 1156-58.

3 Appenzeller T. Filling a hole in the ozoneargument. Science 1993; 262: 990.

Fall in asthma deaths

A fall in deaths from asthma in the USwas reported last week at the annual

meeting of the American College of Aller-gy and Immunology. R Michael Sly andLynelle C Granady (Washington DC)examined data from the National Centerfor Health Statistics up to 1990, the latest

year for which information was available.

They found that although death rates rosefrom 0-8 per 100 000 to 2-0 per 100 000

between 1977 and 1989, the rate fell to

1-9 per 100 000 in 1990. The rise duringthe 1980s was especially severe amongAfrican-Americans. Their rates per 100000 rose from 1-5 to 3-5 between 1977

and 1988, and was 3-4 in 1990 (the cor-responding mortality figures for whiteswere almost one-third those of blacks at

0-5, 1-2, and 1-2). Death rates for thoseaged 5-34 years of age also stabilisedtowards the end of the 1980s. In 1980,the rate per 100 000 was 0-26 and rose toa peak of 0-43 in 1989 where it remainedin 1990.

Granady and Sly also compared asthmaprevalence with morbidity and mortalityin the 0-45-year-old age group. Althoughprevalence rose by over 50% between1982 and 1991 (33-4 per 1000 to 50-7per 1000), there was a plateau during thelast four years of their study interval. Sim-ilarly, death rates rose by over 80% from1979 to 1990 (0-277 per 100000 to 0-504per 100 0000, but plateaued from 1987onwards.

Richard Horton

Castration and cardiologyAre mgn testosterone concentrations

linked to high incidence of atherosclero-sis ? With most men being exceedinglyunwilling to be depleted of the hormonethis question is not easy to resolve. How-ever, Nieschlag and colleagues’ think theyhave found the answer. In a non-prospec-tive, non-randomised study they com-pared the lifespan of castrated male

singers who lived between the sixteenthand the middle of the nineteenth century,with that of uncastrated singers (bass,baritone, and tenors). Over the 277 yearstudy period there was no difference. Themost obvious conclusion is that removalof the testes and therefore influence of

androgens has no effect on the longevityof men. Socioeconomic circumstances,diet, and the average lifespan have

changed in the intervening 150 years, sowhether this conclusion is applicabletoday is another question.

Clare Thompson

1 Nieschlag E, Nieschlag S, Behre HM.Lifespan and testosterone. Nature 1993;366: 215.