The great majority of women evidence few significant problems during the puerperium. Mild affective distress lasting a few hours to a few days and known as the post-partum blues is common but has little effect beyond the first week or two after delivery. Post-partum depression, which has a prevalence of 10-1 5%, is more serious in that it may last for several months and impair a woman's ability to function in her many roles. Clinically and with respect to causal factors post-partum depression appears to resemble depression occurring at other times. Post-partum psychosis is a disabling disorder occurring once in every 1000 deliveries. Intensive treatment, usually on an inpatient basis, is required. Women with previous psychosis or a family history of psychosis are at increased risk. Discussion of the consequences of these patterns of post-partum adjustment and recommendations for treatment and future research are presented. J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by McMaster University on 11/03/14 For personal use only.
206studied [l-61. The adjustment that some women make during the puerperium is not optimal, however, and this poor adjustment is reflected in psychiatric disturbance, particularly depression.Post-partum mood disturbances are commonly classified into 3 categories in order of increasing severity: blues, depression, and psychosis. These 3 conditions will be discussed separately in this review; nevertheless, it should be noted that there is little evidence that they actually represent 3 distinct states. The purpose of this review is to: (a) describe each of the 3 conditions, (b) present data regarding incidence and prevalence, (c) review the more adequate studies of causal and associated factors, and (d) discuss issues related to treatment and consequences of these conditions.
Post-partum blues
Description and diagnosisPost-partum blues refers to a mild affective syndrome often seen in the first week after delivery. The blues is characterized by symptoms such as depressed mood, crying spells, irritability, anxiety, mood lability, confusion, and sleep and appetite disturbance [7-91. Although the term 'blues' gives emphasis to the aspects of sadness or depression, for many women symptoms such as crying, confusion, anxiety, and mood lability are quite prominent [e.g., 8,9].Several sets of criteria have been developed to diagnose the blues (see Table I). For example, Pitt [8] diagnosed patients as having the blues if they felt tearful and depressed in the first 6-8 weeks post partum. He also developed a rating scale that included blues symptoms identified by Hamilton [7] such as fatigue, crying, anxiety, confusion, headaches, insomnia, hypochondriasis, and hostility to husband. Handley et al.[lo] developed a semistructured interview to assess the following symptoms of the blues: overall dysphoric mood, mood lability, number of crying episodes, anxiety, insomnia, lack of appetite, and irritability. They did not make clear, however, the criteria necessary for making a diagnosis of t...