women mental health

7/21/2019 Women Mental Health

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Women Mental Health:Postpartum Depression

A.Fitrikasari Sutomo



INCIDENCE OF DEPRESSION

• Each ear! "#$ to %&$ o' a(ults in the)nite( States e*+erience a ma,or(e+ression

• -he inci(ence amon /omen is t/ice

that o' men an( +eaks 0et/een "1 to22 ears o' ae 3 the chil(0earin ears



DEPRESSION IN WOMEN

• Women are at increase( risk o' moo((isor(ers (urin +erio(s o' hormonal4uctuation3

– +remenstrual

– +ost+artum

– +erimeno+ausal



Women are at serious risk 'or(e5elo+in a +schiatricillness a'ter chil(0irth.

D. Wolocko, Daily News



Post+artum mothers are atsini6cant risk o' (e5elo+in a

+schiatric illness se5ereenouh to re7uire hos+itali8ationas the ne*t sli(e (emonstrates.

-his increase( risk lasts 'ora0out t/o ears a'ter chil(0irth.



9Post+artum De+ression is aeneral term use( in our

societ to (escri0e any +schiatric illness occurrin

a'ter chil(0irth.



In realit! Post+artum De+ression

(escri0es onl one o' 'oursn(romes that can occur

a'ter chil(0irth.



-he 'our sn(romes are:

• Maternit or Post+artum ;lues

• Post+artum Pschosis

• A(,ustment Disor(er o' thePost+artum Perio(

• Ma,or De+ression in the Post+artum

<Post+artum De+ression=



)n'ortunatel! common re'erence to

all 'our con(itions as9Post+artum De+ression creates

con'usion an( 'ear.

It is im+ortant to un(erstan( thatPost+artum Pschosis! the mostse5ere an( (anerous con(ition! isrelati5el rare an( 7uite (i>erent

'rom Post+artum De+ression! as thene*t sli(e (emonstrates.


http://slidepdf.com/reader/full/women-mental-health 10/62Cohen LS. Depress Anxiety. 1998:1:18-26.

Transient,Transient,nonatholo!icnonatholo!ic

"e#ical"e#icale$er!encye$er!ency

Serio%s,Serio%s,#isa&lin!#isa&lin!

'ostart%$ (l%es

'ostart%$ Deression

'ostart%$ 'sychosis

)*+ to *+

1*+

*.*1+

2/3 have onset by

6 wks postpartum

↑risk for Postpartum

↑ Depression

70% are affetive!"ipo#ar$ a&or

Depression'

S+ectrum o' Post+artumMoo( Chanes

I n

c i

d e

n c e

I n

c i

d e

n c e



Post+artum Pschosisis o'ten misla0ele( in

the me(ia as

Post+artum De+ression!creatin much an*iet an(

'ear in /omen /ith the lessse5ere +ost+artum (isor(ers.



Maternit or Post+artum;lues

• Is not consi(ere( a +schiatric illnessan( is unrelate( to +schiatrichistor .

• Occurs in %? to 1#$ o' 0irthinmothers. -he e*act inci(ence isunclear.

• Present in all cultures stu(ie(• A++ears unrelate( to

en5ironmental stressors



Maternit or Post+artum;lues

9;lues @ heihtene( reacti5it!not clinical

(e+ression

• Moo( s/ins 'rom /ee+iness to e*tremeha++iness an( heihtene( reacti5it

• Occurs to # (as a'ter chil(0irth. It is sel'limitin! resol5in in a0out a /eek.

• I' occurs! increases risk 'orPost+artum De+ression.



-he rest o'the sn(romes to 0e(escri0e( are all

consi(ere(+schiatric illnesses

an( 0ene6t 'rom clinicaltreatment.



Post+artum Pschosis

• Is relati5el rare! occurrin one to threecases +er "&&& 0irths

• Is a se5ere an( li'e threatenin con(ition 'or0oth mother an( in'ant

• De5elo+s soon a'ter 0irth! o'ten /ithin t/o/eeks! usuall /ithin a month

• Re7uires intense treatment an(hos+itali8ation: A me(ical emerenc

• Is usuall 'ollo/e( 0 Post+artum De+ression



Sm+toms o' Post+artumPschosis

• Delusions: False 0elie's! o'ten o' areliious nature an( 5er 're7uentlin5ol5in the in'ant

• Perce+tual (istortions: Seein orhearin thins /hich are not +resent

• O'ten! 'eelins o' e*cessi5e /ell0ein or im+ortance



A(,ustment Disor(er o' thePost+artum Perio(

• Occurs in a0out %&$ o' 0irthin mothers0ut inci(ence is unclear as man /omen/ith this +ro0lem (o not seek treatment.

• Mani'ests as excessive (iBcultiesa(,ustin to motherhoo(.

• I' emotional sm+toms e*ist! the are notas se5ere as those seen in Post+artumDe+ression

(ri!ht. Am (am Physiian. 199 )*: )9).S%ri an# (%rt. ) Prat Psyhiatry "ehav *ea#th. 199 /: 6.



A(,ustment Disor(er o' thePost+artum Perio(

• Can resol5e /ithout treatment o5ertime 0ut can cause onoin(iBculties 'or the mother.

• Can (e5elo+ intoPost+artum De+ression i' more

se5ere an( untreate(.

• Res+on(s /ell toshort term +schothera+.




Post+artum De+ression

• Occurs in "&$ o' 0irthin mothers

– %&$ i' the mother has ha( Maternit;lues.

• Occurs usuall /ithin ? /eeks o'0irth 0ut can occur u+ to a ear a'ter0irth




• ?.1$ to "?.#$ o' /omen e*+erience+ost +artum (e+ression <PPD= alsokno/n as +oat +artum ma,or

(e+ression <PMD=

• Onset can 0e as earl as %2 hours oras late as se5eral months 'ollo/in

(eli5er



Onset o' Sm+toms inPost+artum De+ression

-/o Stu(ies

2. Time of Onset of Postpartum Depression in 413 Patients

The $ore severe, the ear#ier the onset.

0

20

40

60

Within Two Weeks Si Weeks Si !onths

P e r " e n t a # e

o f P a

t i e n t s Se$ere% nee&e& hospita' a&mission

!i'&% treate& () #enera' pra"titioner

1. Time of Onset of Postpartum Depression in 31* WomenWithin 1 Days

6+

Within 6 Weeks

1+

Within / "onths

22+

Within 6 "onths

18+



Post+artum De+ression:Sm+tom Onset

• *+: 0ter irst ostnatal isit

– 0t 6 weeks

• 2*+: Coinci#e# with weanin!

• 16+: 0t ret%rn o $enstr%ation – 0t 2 to / $onths i not &reast ee#in!

• 1+: 3nitiation o oral contraceties




• Mani'ests as sm+toms o'(e+ression! o'ten /ith marke(an*ietaitation an( o0sessions

a0out harm comin to the chil(.

• Can (e5elo+ ra(uall ora0ru+tl a'ter 0irth




What are the sm+toms o'De+ression

– Sa(ness o' moo( most o' the (a! nearl e5er(a

– Diminishe( interest or +leasure in usualacti5ities

– Ma,or chane in a++etite or /eiht

– Not a0le to slee+ or slee+in too much – Aitation or 'eelin slo/e( (o/n

– Fatiue or loss o' ener

– Feelins o' /orthlessness or e*cessi5e or ina++ro+riateuilt

– Diminishe( a0ilit to think or concentrate! orin(ecisi5eness

– Recurrent thouhts o' (eath! (in! or suici(e

0'0 Dia!nostic an# Statistical "an%al. 199



SMP-OMS OF POS-PAR-)MDEPRESSION

Hopelessness Loss of pleasure in activities

Helplessness Mood changes

Persistent sadness Inability to adjust to role of motherhood

Irritability Inability to concentrate

Low self-esteem Sleep /appetite disturbances

Sm+toms



Sm+toms Fre7uentl Seen in


• Marke( aitation an( an*iet• Mother can not slee+ e5en /hen

the 0a0 is slee+in

• O0sessions an( com+ulsionsa0out the 0a0



RANE OF SMP-OMS

• Sm+toms rane3

– 'rom mil( (s+horia

– to suici(al i(eation

– to +schotic (e+ression



D)RA-ION OF SMP-OMS

• )ntreate(! sm+toms can last:

– se5eral months

– into the secon( ear +ost+artum



-HE E-IOGO OF POS-PAR-)MDEPRESSION

• arious theories 0ase( in+hsioloical chanes ha5e 0een

+ostulate(: – hormonal e*cesses or (e6ciencies o'

estroen! +roesterone! +rolactin!

thro*ine! tr+to+han! amon others



E-IOGO OF POS-PAR-)MDEPRESSION

• Other theories cite numerous+schosocial 'actors associate( /ith

PMD: – marital con4ict

– chil(3care (iBculties <'ee(in! slee+in!health +ro0lems=

– +erce+tion 0 mother o' an in'ant /ith a(iBcult tem+erament

– histor o' 'amil or +ersonal (e+ression



INDICDENCE OF POS-PAR-)MDEPRESSION AMON %&&&)-AH PRAMS RESPONDEN-S

• %2."$ o' PRAMS res+on(entsin(icate( that in the months a'ter

(eli5er the /ere mo(eratel to5er (e+resse(



Hiher rates o' (e+ression /erenote( amon /omen /ho:



-HE IMPAC- OF

POS-PAR-)M DEPRESSION



GON -ERM CONSE)ENCESOF PMD

• Neati5e im+act on the in'ant Jssocial! emotional an( coniti5e(e5elo+ment

– % month ol( in'ants o' mothers /ith PMD

ha( (ecrease( coniti5e a0ilit an(e*+resse( more neati5e emotions(urin testin



GON -ERM CONSE)ENCESOF PMD

• ;a0ies o' mothers/ith PMD /ere

+ercei5e( 0 theirmothers as more(iBcult to care 'oran( more

0othersome.



POS-PAR-)M DEPRESSION K

MA-ERNAG MOR-AGI- IN)-AH

• In recent ears! there ha5e 0eent/o maternal (eaths (ue to suici(e0 /omen /ithin one ear o'

i5in 0irth.• Neither /oman ha( 0een screene('or +ost+artum (e+ression



-here are risk 'actors that

+re(is+ose /omen to+ost+artum (isor(ers.



RISL FAC-ORS FOR PMD

-amily history of mood

disorder

-!hild-care difficulties"

feeding# sleeping# health

-!lient history of mood

disorder prior to pregnancy

-Marital conflict

-$n%iety/depression during

pregnancy

-Stressful life events

-Previous postpartum

depression

-Poor social support

-&aby blues following current

delivery



• First +renanc

• oun ae

• Pschiatric illness (urin +renanc

• Prior histor o' +ost+artum illness

• Prior histor o' mental illness

• Famil histor o' mental illness

• Recent stress'ul li'e e5ents

• Pro0lems in the marriae



In a((ition! there are mansocietal an( cultural 'actors

that ma +re(is+ose /omento +ost+artum +ro0lems

inclu(in...



• Isolation

• Diminishe( e*ten(e( 'amilin5ol5ement

• Distorte( an( lamori8e( +erce+tionso' +renanc



• Reco5er in the +ost +artum

• Fre7uentl +romote( in the me(ia

• )nrealistic e*+ectations o' the+ost+artum mother



-REA-MEN-

• E(ucate the /oman an( her su++ortsstem rear(in the (ianosis o'

+ost+artum (e+ression.



-REA-MEN- OP-IONS

• Pharmacoloical inter5ention

• Counselin! in(i5i(ual an(or rou+

• Su++ort rou+s



PHARMACOGOICAGIN-EREN-ION

• )se o' tricclic anti(e+ressants an(selecti5e serotonin reu+take inhi0itors<SSRIs= ma 0e in(icate( 'or 0oth non3

nursin an( nursin mothers• Ha5e lo/ inci(ence o' in'ant to*icit an(

a(5erse e>ects (urin 0reast'ee(in

• Decisions rear(in use /hile0reast'ee(in must 0e on a case 0 case0asis



O-HER CONSIDERA-IONS:

• Pro5i(er must 0e 'amiliar /ith aentsan( the he+atic 'unction o' motheran( in'ant

• Client must 0e in'orme( o'risks0ene6ts o' treatment s. notreatment 'or hersel' an( her in'ant

– unkno/n im+act o' lon3term use o'me(ications on neuro(e5elo+ment o'in'ant



Other Consi(erations 3Cont.

• I' the /oman chooses to 0reast'ee(/hile on +schotro+ics! she shoul(/ork colla0orati5el /ith a

+schiatrist an( her +e(iatrician• I' the in'ant e*+eriences insomnia orother 0eha5ior chanes! his serumshoul( 0e assae( 'or the +resence o'

me(ication• Document all (iscussions rear(in

treatment in the clients chart



CO)NSEGIN

• Lno/ re'erral sources in our locale!es+eciall those that: – acce+t Me(icai(

– utili8e a sli(in 'ee – /ill (e5elo+ a +ament +lan /ith theclient

– o>er 'ree counselin

• ;e 'amiliar /ith in(ient (ru+rorams a5aila0le throuh 5arious+harmaceutical manu'acturers



Counselin 3 Cont.

• An /oman /ith sm+toms o'+schosis or /ith serioussuici(alhomici(al i(eation shoul( 0e

re'erre( 'or emerenc +schiatrice5aluation



S)PPOR- RO)PS

• Numerous +ost+artum su++ort

rou+s are a5aila0le. Contact:• Gocal mental health aencies

• Hos+itals

• We0sites



What a0out

0reast 'ee(in

-he inci(ence o' 0reast

'ee(in in 0irthin mothers isincreasin as the ne*t sli(e

sho/s.



Althouh the +resence o'

o0sessions an( com+ulsionsin(icates nee( 'or treatment!

these mothers are rarel

(anerous to the in'ants. -heare actuall at hiher risk to hurt

themsel5es as a result o' their

'ear o' +ossi0l hurtin thein'ant.

Inci(ence o' ;reast Fee(in



Inci(ence o' ;reast Fee(in"%?3%&&"

80%

49%

28%

20%

37%

52%

6+61%

1926-

1930

1951-

1955

1966-

1970

1972 1975 1998 2000 2001

Briggs, Freeman, Yafee, Drugs in Pregnancy and Lactation, 1998

Maternity Surey, Parents Express, !"i#$,!$, 4&01, 4&02



a reasona0lea reasona0leo+tiono+tion

in Post+artumin Post+artum

(reast ee#in!4(reast ee#in!4

Wh t 0 i (



What are o0sessions an(com+ulsions

• An o0session is a re+etiti5e! intrusi5e an((istur0in thouht that enters the min(an( is out o' the in(i5i(ualQs control.

• A com+ulsion is a re+etiti5e act that is(one in an attem+t to 0e ri( o' theo0sessional thouht.

• ;oth cause reat an*iet an( (iscom'ort

in the in(i5i(ual.



Post+artum o0sessions

• Commonl 'ocuse( on in'ant

• -houhts<o0sessions= o' hurtin the in'ant – Dro++in in'ant

– Dro/nin in'ant – Sta00in in'ant

– Puttin in'ant in o5en or micro/a5e

– Se*uall a0usin in'ant

– -houhts that someone /ill steal orharm the in'ant



Post+artum com+ulsions

• Commonl 'ollo/ the o0sessions as anattem+t to alle5iate the thouht

– A5oi( hol(in 0a0 0 staircases! etc

– A5oi( 0athin in'ant – Hi(e kni5es

– A5oi( kitchen area

– A5oi( chanin (ia+ers or 0athin in'ant

– A5oi( lea5in the house



Althouh all me(icationscross into 0reast milk! thereare a 'e/ anti(e+ressants

that a++ear to cross less thanothers an( ma 0e sa'er in0reast 'ee(in. Consult

our (octor.



In summar! +ost+artum

+schiatric illness e*ists. Itcan 0e (e0ilitatin an((anerous to 0oth mother

an( chil(.E>ecti5e treatments area5aila0le. Su++ort rou+s o'

mothers in reco5er are alsoa5aila0le in man areas

o' the countr.



Re'erences

• ". ;eck A-! War(! CH! Men(elson M! Mock ! Er0auh . Anin5entor 'or measurin (e+ression. Archi5es o' eneralPschiatr. <une "?"=. 2:?:#?"3#".

• %. Co* G! Hol(en! M! Sao5sk R. E(in0urh Postnatal De+ressionScale <EPDS=. ;ritish ournal o' Pschiatr. <"1=. "#&:1%31?.

• . E++erson CN. Post+artum ma,or (e+ression: (etection K

treatment. American Famil Phsician. <A+ril "#! "=. #:1:%%23%%#2.

• 2. Man(l LD! -ronick ET! ;rennan -A! Al+ert HR! Homer . In'anthealth care use an( maternal (e+ression. Archi5es o' Pe(iatricA(olescent Me(icine. <"=. "#:<1=:1&131".

• #. Sto/e T. De+ression a'ter chil(0irth: I it the 90a0 0lues orsomethin more P68er Inc. anuar "1.

• ?. Sto/e TN! Nemero> C;. Women at risk 'or +ost+artum3onsetma,or (e+ression. American ournal o' O0stetrics K necolo.<Auust "#=. ":%:?3?2#.

• . )tah De+artment o' Health. <%&&"=. U)ntitle(V. )n+u0lishe(Maternal Mortalit Re5ie/ Proram (ata.



Re'erences <cont.=

• 1. )tah De+artment o' Health. <%&&"=. U)ntitle(V. )n+u0lishe(PRAMS (ata.

• . Whi>en E! otli0 IH. In'ants o' +ost+artum (e+resse(mothers: tem+erament an( coniti5e status. ournal o' A0normalPscholo. <"1=. 1::%23%.

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