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Epidemiological studies of puerperal samples have consistently revealed the prevalence of non-psychotic major depressive disorder in the early weeks after delivery to be around 10%.1Although this rate does not, in fact, represent an elevation over the non-postpartum base rate,2-5 the inception rate for depression does appear to be raised in the first three months postpartum compared with the following nine months.5 6There has been considerable clinical and research attention paid to postpartum depression in recent years, in part because it occurs at a particularly important time in a woman’s life: the early postpartum period is the time when the foundation of the mother-child relationship is laid. Indeed, a large body of evidence attests to the fact that postpartum depression does have an adverse impact on the progress of this important early period. Thus, compared with well mothers, mothers with postpartum depression report significantly higher rates of problems with infant feeding, crying and sleeping, as well as more problems with their relationship with their infant.7 Also, ratings of the quality of the early mother-infant relationship reveal it to be profoundly affected by the presence of postpartum depression.8 Furthermore, longitudinal studies have revealed that the nature of the early mother-infant relationship in the context of postpartum depression is predictive of the course of child cognitive, emotional, and social development.8 For these reasons, there has been a substantial research effort in recent years to elucidate aetiological factors, to develop methods of prediction, to refine a system for reliable detection, and to develop and evaluate methods of treatment which can be delivered widely within the health service.
Aetiology
There is scant evidence for a biological basis to postpartum depression.1 Although the presence of the ‘maternity blues’ has been found in a number of studies to be …