Lingering fatigue a warning sign for postpartum depression
Fatigue that lingers too long after childbirth could be an early sign of postpartum depression.
In research presented recently at the Scientific Session of the Eastern Nursing Research Society, in University Park, USA, investigators offered new evidence that fatigue could, in fact, act as an important marker for identifying new mothers who are at risk for such depression before any classic symptoms appear.
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"All women feel fatigue after childbirth and for several weeks afterwards. But in most women, we see a curve -- the fatigue gradually lessens over time," says study author Elizabeth Corwin, an assistant professor at the Penn State School of Nursing.
Fatigue continues
In women who are prone to postpartum depression, however, Corwin says that doesn't happen.
"These women feel as tired on day 14 as they felt on day 7, indicating the fatigue isn't letting up," says Corwin. And it is that persistence, she adds, that could indicate which women may go on to develop postpartum depression.
Characterized as an overwhelming and increasing sense of sadness that builds over time, postpartum depression affects up to 20 percent of all new mothers. Unlike postpartum "blues", which is a transitory sense of sadness that affects up to 80 percent of new mothers and usually clears within six weeks, postpartum depression may only be fully recognized two to three months after giving birth.
Postpartum psychosis
Postpartum psychosis, the most serious form of this disease, was recently brought to light during the trial of convicted murder Andrea Yates. It affects about one to two women out of every 1,000 who give birth.
Reproductive psychiatrist Dr. Shari Lusskin agrees that fatigue is an important risk factor, but she says the study finding isn't exactly new.
"We have long known that fatigue and depression go hand-in-hand. Therefore, I think if these women were given a standard depression test on day 14, their risk of postpartum depression may have been revealed as well, and possibly with more accuracy," says Lusskin, an associate professor of psychiatry at New York University School of Medicine.
Corwin disagrees: "We found that at the two-week mark, most of the women who expressed extreme fatigue had no classic signs of depression, so they may have been overlooked by a classic diagnostic test," she says.
The study
To conduct the study, researchers recruited 38 new mothers from the Centre Community Hospital in State College, Pa. The research team visited the women four times: 24 hours after childbirth, and on the seventh, 14th and 28th day after the birth.
On day 14, the researchers gave the new mothers a questionnaire designed to assess their level of fatigue. On the last visit, they administered a standard questionnaire test on depression.
They then calculated and compared the answers from both sets of questions.
What they found was: Women who reported feeling a continuing sense of fatigue on day 14 also scored higher on the depression scale administered on day 28.
Accurate predictor
Corwin says the simple, 20-question test on fatigue turned out to be 93 percent accurate in predicting who would suffer moderate to severe depression, as indicated by the depression scale test taken on day 28. In fact, she adds, only five women who reported continuing fatigue did not go on to develop postpartum depression.
Corwin says that by using the fatigue questionnaire, paediatricians conducting the first well-baby visit -- usually around day 14 -- can help identify mothers at highest risk for depression, and offer intervention strategies before problems take hold.
"I think the key finding here is that fatigue which either does not begin to lift within two weeks after childbirth, or increases and actually grows worse over time, is a good indicator that a woman is heading for postpartum depression -- and it's important that intervention take place as soon as possible," says Corwin.
Six-week postpartum blues
Although sometimes the "six-week postpartum blues" can progress to full-blown postpartum depression, women who suffer postpartum depression do not transgress to postpartum psychosis. This, says Corwin, is a completely different disorder.
To help ascertain further risk factors for postpartum depression, the study also looked at breast-feeding vs. bottle-feeding, the presence of other children in the family, whether the women had partners, and previous bouts of postpartum depression. The researchers report none of these factors appeared to make a difference or affect the findings.
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