Mental illness hits 1 in 1,000 new mothers

Danish study shows need to recognize and treat severe postpartum conditions

December 06, 2006|By Ronald Kotulak | Ronald Kotulak,Chicago Tribune

Within three months after giving birth to their first baby, one out of 1,000 women suffer from schizophrenia, bipolar disorder, depression or some other psychotic condition severe enough for them to be hospitalized, according to a large Danish study.

The findings underscore a potentially perilous period after delivery when key hormones such as estrogen and progesterone, which are elevated during pregnancy, fall precipitously, possibly triggering mental disorders in susceptible women.

"This is a really important study," said Dr. Valerie Davis-Raskin, a former associate clinical professor at the University of Chicago, who treats patients with postpartum depression. "We've had a difficult time figuring out what causes postpartum psychiatric illnesses, and I see this study as really strongly supporting a biologic, hormonal or other physical basis."

"All women go through this massive hormonal change after delivering a baby," said Davis-Raskin, who was not involved in the study. "It's such a stressor on the mother's brain."

An estimated 60 percent to 70 percent of new mothers experience postpartum blues, a mild mood disorder that lasts one to two weeks. But 10 percent to 15 percent suffer postpartum depression, a more serious mental disorder that can last weeks to months.

The Danish study, reported in today's issue of The Journal of the American Medical Association, shows that postpartum psychoses are a bigger problem than generally recognized, wrote Katherine Wisner, a professor of psychiatry and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine in an accompanying JAMA editorial.

Postpartum depression is a major public health problem, Wisner said. She called for universal screening programs to be set up to diagnose and treat mental problems of new mothers. Screening should start at two weeks after childbirth and continue at regular intervals for the first year, she said.

Maternal depression can adversely affect a newborn's mental and motor development and is associated with poor impulse control, low self-esteem and behavior problems as the child develops, Wisner said.

Despite effective therapies for depression and psychoses, maternal mental problems are often not recognized or treated, she said.

Earlier this year, New Jersey became the first state to pass a law requiring postpartum screening for all new mothers.

The Danish study is the first in more than two decades to look at the problem of serious psychoses in women after childbirth. It is considered important because the health records of all Danish citizens are carefully maintained, including all psychiatric hospital admissions.

The study, headed by Trine Munk-Olsen of the University of Aarhus, Denmark, involved 630,373 women and 547,431 men who became new parents between 1973 and 2005. The researchers found 1.03 women per 1,000 births suffered from a mental disorder requiring hospital admission.

Being a first-time father did not affect the rate of mental disorders among men, Munk-Olsen said. For new fathers, the rate of hospitalizations for mental illness was 0.37 per 1,000 births, a rate that did not differ from the general male population.

"This may indicate that the causes of postpartum mental disorders are more strongly linked to an altered physiological process related to pregnancy and childbirth than psychosocial aspects of motherhood," said Munk-Olsen.

During pregnancy, when hormone levels are high, the study found, the rate of mental problems declines sharply indicating that elevated estrogen and progesterone levels might provide some sort of protective factor. As these hormones drop off after childbirth, psychiatric illnesses increase.

"It supports what I see clinically," said Davis-Raskin. "If you go out and shovel snow and you have chest pain or a heart attack, the snow didn't cause it. It uncovered something that was there. I think that's what childbirth does for many women with mood disorders, particularly bipolar or a tendency for psychotic disorders."

Carol Blocker saw her daughter Melanie Stokes' mental status deteriorate almost the instant she gave birth six years ago. Melanie went from being bright, happy and eagerly awaiting the birth of her baby to a deep depression and eventually hallucinations.

"Everything she said from that point on was like, `Mommy, I have to die,'" Blocker said. "I said, `Melanie, whatever this is, we're going to work through it.' And she said, `No, I don't think so, Mommy. I want you to go and buy yourself a real nice outfit to come to my funeral.'

"I took her from doctor to doctor and no one said, `OK, there's something called postpartum psychosis that affects new mothers, and I think Melanie might have this and this is what we'll do," Blocker said.

Four months later Melanie checked into a hotel, asked for a room on the top floor, wrote notes to her mother and a few others, then jumped out a window.

Dr. Katherine Marshall Moore, a Mayo Clinic psychiatrist, said screening new mothers for psychiatric disorders should become routine because these problems frequently are unrecognized.

Ronald Kotulak writes for the Chicago Tribune.

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