Sarah

Miller
BIOL 381 Public Health and Nutrition
Dr. Kirsten Page
19 January 2017

Global Health Profile: Postpartum Depression in Developing Countries

Postpartum depression is a mood disorder that may occur in women after
giving birth. It occurs all over the world, but this health profile will focus on the
issue of postpartum depression specifically in developing countries and regions.
This profile will give a brief explanation of the causes and effects of the disorder, the
history of postpartum depression, and its distribution and prevalence in developing
countries.
The causes of postpartum depression are still being researched, and there is
much debate and controversy around the subject. According to the National
Institute of Mental Health (2016), postpartum depression is difficult to predict and
prevent because it usually results from a complex combination of physical,
emotional, and psychosocial factors that are largely outside of a mothers control,
and affect each woman differently. For example, after giving birth, a womans
estrogen and progesterone hormone levels drop quickly. The sudden chemical
changes in a womans brain and body may trigger mood swings that lead to
depression. Some studies claim that a history of strong premenstrual mood changes
may increase a womans risk of responding negatively to the hormonal changes
(World Health Organization, 2009).
Another significant factor is frequent sleep deprivation, a natural result of
caring for a newborn. Without sufficient rest, a new mother may have trouble
properly recovering from childbirth, experiencing continued physical discomfort,
fatigue, and mental and emotional exhaustion. Studies have shown that women with
a history of depression or other affective illnesses are at especially high risk of
postpartum depression (Andrews-Fike, 1999). Other factors may include
postpartum hemorrhage and lactation. These are associated with iron deficiency,
which may contribute to fatigue and a depressed mood. Social factors may also
contribute, as women with poor social support or lack of access to assistance in
crises have been found to be at higher risk of postpartum depression (World Health
Organization, 2009).
Although less common than maternal postpartum depression, paternal
postpartum depression is also a reality. A Brazilian study found that there is
increased risk for a father to experience postpartum depression when his partner is
affected by it, especially moderate to severe depression (Pinheiro, Magalhaes, Horta,
Da Silva, Pinto, 2006). An additional study among low-income families found
chronic sleep disturbance to be a strong predictor of postpartum depression among
couples (Eunice Kennedy Shriver National Institute, 2016).
Symptoms of postpartum depression are similar to those of other depressive
disorders, and typically occur within four weeks after giving birth, but possibly as
late as thirty weeks (Andrews-Fike, 1999). Symptoms include feeling hopeless, sad,
or overwhelmed, moodiness and irritability, increased worry and anxiety, sleeping
too much or being unable to fall asleep, intense rage and anger, difficulty
concentrating and remembering details, difficulty making decisions, loss of interest
in normal activities, isolating oneself from friends and family, and overeating or not
eating enough (National Institute of Mental Health, 2016). Symptoms unique to
postpartum depression include a mothers difficulty bonding with and forming an
emotional attachment to her baby, doubts about her ability to take care of her baby,
and thoughts about harming herself or her child.
Although postpartum depression has likely existed for as long as women
have been giving birth, studies have only recently ramped up in the last few
decades, along with other depressive disorder research. A 1987 article in The
British Journal of Psychiatry indicates that a 1968 study may have been the first
formal recognition of maternal postpartum depression symptoms (Cox, Holden,
Sagovsky, 1987). The article also cites several studies from the early 1980s that
provided confirmation of postpartum psychiatric disorder.
This same 1987 article, written by Scottish researchers at an Edinburgh
health center, lays out parameters for detecting postpartum depression in a tool
called the 10-item Edinburgh Postnatal Depression Scale, now referred to in
shorthand as EPDS. The scale consists of a self-reporting questionnaire regarding a
new mothers mood and thoughts, and is intended to be a screening device for
depressive symptoms, not a true diagnostic tool (Cox et al, 1987). The scale is still
used today, though often in some variation.
Postpartum depression, like most depressive disorders, occurs everywhere
that there are people. However, recent studies have shown that women living in
developing countries and regions are at significantly higher risk of depression than
women in the developed world. The World Health Organization (2009) estimates
that 10-15% of women in industrialized countries, and 20-40% of women in
developing countries experience depression during pregnancy or after childbirth.
The impacts of depression are especially amplified in developing regions, as the
context of poverty, social adversity, and lack of resources and healthcare makes it
even more difficult for a new mother to recover while providing proper care for her
child. This puts the childs health and wellbeing at risk too, as new evidence suggests
that maternal depression in developing countries may contribute to infant risk of
growth impairment and illness through inadvertent reduced attention to and care of
childrens needs" (World Health Organization, 2009).
Despite the wide-reaching effects that postpartum depression and other
depressive disorders have on populations, there is far too little attention and
treatment directed towards the issue. Mental disorders account for 7.4 % of the
global burden of disease; yet mental health receives only about 2.5% of health-
related spending worldwide and approximately 1% in low-income countries
(Hendler, Kidia, Machando, Crooks, Katz, Thornicroft, Semrau, Jack, 2016). Research
indicates that increasing treatment of mental health issues in developing countries
would have extremely positive ripple effects for other aspects of health. With
postpartum depression specifically, evidence indicates that treatment can reduce
maternal morbidity and mortality rates, reduce the likelihood of mental or
behavioral disorders in children, and increase overall physical health, quality of life,
and social functioning (World Health Organization, 2009).

 Works Cited

Andrews-Fike, C. (1999). A review of postpartum depression. The Primary Care
Companion to the Journal of Clinical Psychiatry, 1 (1), 9-14. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/.
Cox, J., Holden, J., Sagovsky, R. (1987). Detection of postnatal depression:
development of the 10-item Edinburgh postnatal depression scale. British
Journal of Psychiatry, 150 (6), 782-786. Doi: 10.1192/bjp.150.6.782. Retrieved
from: http://bjp.rcpsych.org/content/150/6/782.full-text.pdf+html.
Eunice Kennedy Shriver National Institute. (2016). Sleep quality predicts
persistence of parental postpartum depression symptoms and transmission
of depressive symptoms from mothers to fathers. Annals of Behavioral
Medicine, 50 (6), 862-875. Doi: 10.1007/s12160-016-9815-7.
Hendler, R., Kidia, K., Machando, D., Crooks, M., Mangezi, W., Abas, M., Katz, C.,
Thoricroft, G., Semrau, M., and Jack, H. (2016). We Are Not Really Marketing
Mental Health: Mental Health Advocacy in Zimbabwe. Plos One, 11(9). Doi:
10.1371/journal.pone.0161860.
National Institute of Mental Health. (2016). Postpartum depression facts. National
Institute of Mental Health Publications. Retrieved from:
https://www.nimh.nih.gov/health/publications/postpartum-depression-
facts/index.shtml.
Pinheiro, R., Magalhaes, P., Horta, B., Da Silva, R., Pinto, S. (2006) Is paternal
postpartum depression associated with maternal postpartum depression?
Population-based study in Brazil. Acta Psychiatrica Scandinavica, 113 (3),
230-232. Doi: 10.1111/j.1600-0447.2005.00708.x.
World Health Organization. (2009). Mental health aspects of womens reproductive
health: a global review of the literature. Department of Reproductive Health
and Research, World Health Organization.