Lutterman Award Winner for Best Graduate and Professional Student Research: Postpartum Depression is not just a Problem Early On

Background :  Little is known about the onset of depression throughout the extended postpartum period and into early childhood.  This study examines the onset and course of depression over an extended postpartum period (up through eighteen months) among a community representative sample of women.

Design: This was a prospective longitudinal telephone survey of 249 postpartum women, conducted at two weeks, two months, six months and eighteen months after delivery.  Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS), and onset was defined by the first survey screening depressed (EPDS score of 12+ on the 30-point scale). Temporal trends were assessed using generalized estimating equation (GEE) regression.

 Results: There was a significant temporal trend for EPDS scores:  mean EPDS 5.5, 4.3, 4.2, and 4.9 at two-weeks, two-months, six-months and eighteen-months respectively, GEE,p<.001.  Postpartum onset was found to be 6.8%, 2.6%, 2.6% and 6.0% at two-weeks, two-months, six-months and eighteen-months respectively, GEE,p=.068.  The high scores of the early-onset group (mean 14.4 at two-weeks) contributed to the early depression spike, while the high scores of the late-onset group (mean 13.9 at eighteen-months) contributed to the late spike. 

 Conclusions:  Among a community representative sample, two peaks in depression, one early and one late, were identified.  They appear to be the result of two processes: (1) elevated depression symptoms among the full sample that typifies women’s postpartum experience in general, and (2) onset of major depression by two sub-groups of women, one at each time period.  Continued screening beyond the postpartum-obstetric visit is indicated.