Postpartum Depression

There is little evidence to support a biological cause for postpartum depression (O'Hara 1997). Despite extensive research on steroid hormones in women after birth, no firm evidence has emerged linking these hormones to the development of postpartum depression

Several studies have found that the presence of maternity blues in the immediate postpartum period is related to the subsequent development of postpartum depression, but no hormonal basis to this association has been identified (O'Hara 1997). Obstetric factors are important in a vulnerable subgroup of women: amongst those with a previous history of depressive disorder, delivery complications are associated with a raised rate of postpartum depression (Murray and Cartwright 1993; O'Hara 1997).

Epidemiological studies have consistently shown that the major factors of etiological importance are largely psychosocial (O'Hara 1997). Thus, the occurrence of stressful life events, including unemployment, a dysfunctional marital relationship, and the absence of support from family and friends, has been found to raise the risk of postpartum depression. A psychiatric history is also commonly reported to be a risk factor for postnatal depression, especially a history of depressive disorder. The importance of this latter association was clarified in a five-year follow-up study of two subgroups of primiparous women who had had a postpartum depression: those for whom the postpartum depression was a recurrence of previous non-postpartum mood disorder, and those for whom the postpartum depression was their first experience of affective disturbance (Cooper and Murray 1995). The former group was found to be at raised risk for subsequent non-postpartum depression, but not to be at risk for depression following a subsequent delivery. Conversely, the latter group was found to be at raised risk for subsequent postpartum depression but not for subsequent non-postpartum depression. This suggests that for a subgroup of those with postpartum depression the birth of a child carries specific biological or psychological risks.