"Atypical" Depression Following Childbirth

¹ Consultant Psychiatrist, Claybury Hospital, Woodford Bridge, Woolford Green, Essex

It is well known that women are often depressed after child-birth, but only those ill enough to be admitted to hospital have received much study.

A random sample of 305 maternity hospital patients was given a questionnaire designed to measure anxiety and depression associated with childbirth in the seventh month of pregnancy and again 6-8 weeks after delivery. Potential depressives, whose scores had increased, and potential controls, free from depression, with unchanged or diminished scores, were thus obtained, and the diagnosis was confirmed or excluded by clinical interview. Depressives were followed up by questionnaire one year later.

Thirty-three (10-8 per cent.) subjects developed puerperal depression. In only one of these was the illness classical; in the rest it was atypical. Twelve depressives (3.9 per cent. of the total population studied) had not improved after one year. There were also 19 subjects (6.2 per cent.) with new or exacerbated psychological symptoms who were classified as doubtfully depressed.

Depressives differed most from controls in their M.P.I. scores. Their neuroticism scores were highly significantly greater, and their extraversion scores significantly less. It is unsure whether these scores represented their previous personalities, or simply the fact that they were depressed. At probably significant levels, more depressives had a history of recent dysmenorrohea, more had been married for less than three years, fewer had obstetric complications in pregnancy, and more suffered "Maternity Blues" in the early puerperium. There were no significant differences in respect of previous psychiatric, physical or obstetric disorder, age, endocrine abnormality, complicated labour or obvious psychological or social factors.

Atypical depression is, therefore, a common and important complication of the puerperium, about which more needs to be known.

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