Support and Training to Enhance Primary Care for Postpartum Depression

Impact

Many women experience life-changing repercussions from their experience with PPD. If left untreated, PPD can have both immediate and long-term effects on women, their infants, and other family members.

It is critical for providers to understand the impact of PPD on women and their lives for two reasons:

  1. To motivate the provider:
    Understanding the impact of this illness should increase your sense of urgency to assess all postpartum women in your practice and to ensure that those who are experiencing PPD receive treatment.
  2. To educate and engage the patient in assessment and/or treatment:
    As you screen and assess women for PPD, you may find that some patients who are at increased risk for PPD or who are already experiencing the disorder will be reluctant to undergo further assessment and treatment. As a provider, you can use this information about the impact of the untreated disorder on women’s lives to educate these women about their need for further assessment and to ultimately engage them in treatment.
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Impact on Women 31 96

The effects of untreated PPD on women can range from short to long term. Several PPD symptoms, including decreased self-esteem and self-confidence, feelings of guilt or shame at not being a good mother, and difficulty enjoying the baby or motherhood, can continue if not addressed early in the course of the disorder. As with other depressive episodes, the risk of substance abuse is elevated when PPD symptoms remain untreated, or if women try to self-medicate. The risk of suicide also increases the longer symptoms go untreated. Women suffering from untreated PPD may also experience:

  • Difficulty in fulfilling family roles
  • Diminished responsiveness to infant cues
  • Attachment difficulties with their baby/other children
  • Fear of having another baby
  • Financial worries due to inability to work
  • Poor self-care, including following through with healthcare recommendations
  • Increased risk of substance abuse
  • Increased risk for suicidal behaviors or attempts
  • Increased risk for future episodes of depression
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Impact on Infants 11 27

Research shows that infants as young as 2-3 months are affected by maternal depression. Robust findings within child psychopathology literature document the negative impact of maternal depression on the well-being of the child. 84 85 119 Studies indicate high potential for multiple negative child outcomes, both short and long term. For example, depressed mothers make less eye contact with their babies and have a flattened affect, which interrupts the maternal-child attachment process that normally takes place at this age. 98 Less secure parent-child attachment is associated with numerous negative outcomes in children (emotional, cognitive, and behavioral). 56 84 It has been suggested that premature infants are affected more by maternal depression because of their increased need for stimulation. 41 Additional impacts of untreated PPD on infants include:

  • Feeding problems and poor weight gain
  • Increased fussiness and sleep problems
  • Delayed development of cognitive skills, social skills, and expressive language
  • Problems with behavior, conduct, and attention (often become apparent at school age)
  • Poor emotional attachment (reduced mother-infant and father-infant attachment)

Impact on Partner/Family 7 54

The partner and other family members of a woman suffering from PPD are also affected by the disorder. Untreated PPD can lead to instability of marital or family relationships and may increase the likelihood of the woman’s partner developing depression. In addition, partners and other family members may experience:

  • Fear because of their helplessness and lack of control over the situation
  • Anger and resentment due to the disruption of normal life
  • Guilt over the suffering of the new mother
  • Increased instability in marital and family relationships
  • Higher risk of divorce
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Conclusion

This module has provided basic information on the signs and symptoms of PPD and other related illnesses. By now you should have a working understanding of the spectrum of postpartum adjustment, risk factors that make a woman more vulnerable to PPD, and consequences of untreated depression. The next module will help you identify and diagnose PPD using screening tools and clinical interview questions.