Postnatal depression

doi:10.1136/bmj.316.7148.1884

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Peter J Cooper, professor (P.J.Cooper@reading.ac.uk),
Lynne Murray, professor

Winnicott Research Unit, Department of Psychology, University of Reading, Whiteknights, Reading RG6 6AL

Correspondence to: Professor Cooper

There has been considerable recent clinical and research interest in postpartum depression. This has been largely provoked by the accumulating evidence that postnatal depression is associated with disturbances in child cognitive and emotional development.1 This evidence, which is reviewed below, has renewed concern about the epidemiology of postnatal depression, its aetiology, methods of prediction and detection, and the most appropriate form of management.

Summary points

Postnatal depression is associated with disturbances in the mother-infant relationship, which in turn have an adverse impact on the course of child cognitive and emotional development

Postnatal depression affects 10% of women in the weeks immediately post partum

There is little evidence for a biological aetiology; antenatal personal and social factors are more relevant

Postnatal depression is commonly missed by primary care teams despite the fact that simple reliable detection procedures have been developed

The treatment of choice in most cases of postnatal depression is counselling, which can be effectively delivered by health visitors

There is a need to develop preventive intervention strategies

Methods

This article is based on a review of the recent research concerned with the impact of postnatal depression on child development, and the epidemiology, prediction, detection and management of the disorder. Authoritative recent reviews are cited as well as the most impressive research papers. To supplement our immediate knowledge of the literature we performed literature searches with Medline and PsychLit (1980-97) using the relevant key words (“postnatal/postpartum depression” in conjunction with “infant/child development/outcome, epidemiology, aetiology, prediction, detection and treatment”).

Impact on parenting and child outcome

There have been several recent prospective studies of samples of women with postnatal depression and their children.1 They indicate a definite association between the maternal mood disorder and impaired infant cognitive development. Thus, in Cambridge a community sample of children of mothers who had had postnatal depression were found to perform significantly less …