Who Has The Highest Risk for Postpartum Depression?
Image by Fallon Michael on Unsplash A new study published this month in the Journal of Affective Disorders looked at the risk factors for developing postpartum depression. That is, who is most likely to get postpartum depression? What makes one woman more likely to develop postpartum depression than others?
This is a research question that has been asked numerous times. But what set this one apart is the way they conducted the study. They used data that was self-reported by users of a period tracker and pregnancy app, Flo Health via the “After Childbirth Survey.” The advantage of using a digital app to collect these surveys is that they could use the same survey across a large international population (1.135 million women from 138 countries!) and that is way more powerful than the small research-based studies or the collection of many research-based studies ('meta-analysis') that is usually done to answer these questions. Of course, the answers were slightly skewed towards the users of this app, who were mostly from the higher to high middle-income countries. Nevertheless, using a digital app to conduct such studies opens up so many possibilities in asking questions that reach a much larger group than before and it is exciting to see that happen.
What they found can be summarized as:
Postpartum depressive symptoms decreased with advancing maternal age (18-24-year-olds had the highest risk).
First-time mothers reported higher rates of depressive symptoms than women with prior children.
Twin births were associated with a higher symptom burden than singleton births (11.3% of mothers of twins reported symptoms, compared with 8.3% of mothers of a single child).
No clinically significant difference in depressive symptoms between mothers of single girls and boys.
Mothers aged 40 and older who had twins were at particularly high risk (15% of moms in this age group having twins reported postpartum depression symptoms, compared with 6.6% of mothers of one baby!).
The last point really hit home. I was 40 when I had the twins. This is not a new observation. It has been known for a long time that mothers of multiples have a higher risk of developing postpartum depression. I was the poster child for postpartum depression and it would have been a surprise if I didn't get it! My age and the fact that I was carrying twins should have put me on the top of the list for screening for postpartum depression. Forget screening, I wasn't asked even once, 'how are you doing?'
Anyway, that is the past and I won't dwell on it, except making sure that every woman who screens themselves by the Haplomind app is assessed for these risk factors and followed closely for symptoms. What is very important though is that healthcare professionals who are closely associated with the women should have this checklist ready when assessing risk factors for postpartum depression. It is especially relevant because the same health care professionals (Ob/Gyns) will not see the woman after 6-8 weeks of giving birth and this crucial information gets lost somewhere in the ether and the woman 'falls through the cracks.' At the very least, the pediatrician should have a copy of these risk factors in the 'well child' visits, so that they can refer her to a therapist if needed - at the right time.
This is what Haplomind is trying to change - as in how can we be proactive, instead of reactive? How can we educate everyone so that these risk factors (along with others, such as a previous history of depression, etc) are common knowledge and everyone, including the woman and their families, are aware of it and are on high alert? How do we ensure that the woman's medical history and risk profile are available to everyone who cares for her during the perinatal period?
These are some of the questions that we tackle and we hope that there will come one day when screening and treating for postpartum depression (and other mental health conditions during this time) becomes as common as checking the blood pressure of the woman in every healthcare visit.