An estimated 12 percent of women develop major depression within a year of
giving birth, and about 19 percent get minor forms of the illness. Postpartum
depression disrupts maternal-infant bonding and retards infant behavioral and
cognitive development. Yet many at-risk mothers go undiagnosed until the
disease is well established.
Now a simple screening test has been used to identify mothers at risk for
postpartum depression. In a small prospective study, 91 percent of mothers who
scored 6 or above on the Modified Fatigue Symptom Checklist 14 days postpartum
were found to be at increased risk of postpartum depression.
"We found that fatigue and not a history of stress or depression is
the best indicator of which women will go on to develop postpartum
depression," the lead author of the study told Psychiatric
News. She is Elizabeth Corwin, Ph.D., an associate professor of nursing
at Ohio State University.
A report of her study appears in the September/October 2005 Journal of
Obstetric, Gynecological, and Neonatal Nursing.
Corwin's group gave 31 women between 36 and 38 weeks gestation
questionnaires on fatigue, stress, and both symptoms and history of
depression; they also measured the women's cortisol levels. This procedure was
repeated at one, two, and four weeks after delivery. All women had uneventful
By the end of the fourth week, 11 of the 31 women were reported to have
symptoms of depression. Seven had a family history of depression, four of whom
also had a personal history of depression.
The most significant result was that 10 of the 11 women (91 percent) who
showed symptoms of postpartum depression during the fourth and final week of
the study had also reported higher-than-normal levels of fatigue two weeks
earlier. Only one of the 11 women who went on to demonstrate symptoms of
depression had not reported excessive fatigue at that visit.
"A personal history of depression is an excellent way to predict
which women are at risk for postpartum depression," Corwin said."
Still, using that as the sole screening tool would have left seven of
the women undiagnosed.
"Likewise, a family history of depression is a risk factor,"
she went on. "But by using family history alone, we would have missed
four women who went on to develop signs of depression."
While these women reported that they also felt more stressed than normal,
elevated stress levels based on the women's answers to the stress
questionnaire weren't sufficient to predict which women would ultimately
develop postpartum depression. Most of the women in the study reported
higher-than-usual levels of stress during the first month after having their
Also, cortisol levels were highest for all of the women in the study at the
end of their pregnancies and steadily declined during the month after they
gave birth. This ruled out using cortisol level as an indicator of differences
in stress between women who went on to develop depression and those who did
"All mothers are tired after having a baby, but for some women the
fatigue is relentless, and it is very hard to try to be a good mother and take
on the new role when you are so exhausted, Corwin went on. "Little by
little I think these moms don't respond to their babies because they are so
tired, and eventually the babies won't respond to the mothers. Even if the mom
does begin to respond later, she is out of sync with the baby from symptoms of
Other researchers have suggested that fatigue is an initiating factor or
contributor to postpartum depression, and Corwin said she is not the first to
suggest that. But their data were from retrospective studies. Corwin is
believed to be the first to conduct studies that followed mothers
Corwin conducted the study with colleagues from Pennsylvania State
University. Support for the work came from a grant from the Association of
Women's Health, Obstetric, and Neonatal Nurses and the Pennsylvania State
General Clinical Research Center, which is funded by the National Institutes
"The Impact of Fatigue on the Development of Postpartum
Depression" is posted at<http://jognn.awhonn.org/cgi/content/abstract/34/5/577>.▪
J Obstet Gynecol Neonatal Nurs