Races Share Factors for Postpartum Depression

Black and Hispanic women report more symptoms of depression following the birth of a child than white women.

Nevertheless, a new study shows that the factors underlying postpartum depression remain the same regardless of race or ethnicity.

Click here for Web MD's "Facts About Postpartum Depression."

Elizabeth A. Howell, MD, of New York's Mount Sinai School of Medicine, led a team that held telephone interviews with 655 white, black, and Hispanic women. They conducted the interviews two to six weeks after the women gave birth to healthy, normal-weight children.

Howard Leventhal, PhD, director of the center for health beliefs and behavior at New Jersey's Rutgers University, was a member of the research team.

"We are dealing here with depressive symptoms -- feelings of being sad and blue and disconnected from life that interfere with everyday activities -- not major depressive disorders," Leventhal tells WebMD. "The big story is that it is all the stresses following the delivery that create this depression. It is not because one has a depressed personality."

Some of these women, Howell notes, probably did suffer from more serious depression. According to the National Women's Health Information Center of the Department of Health and Human Services, about 10 percent to 15 percent of new mothers suffer this more serious depression. Nevertheless, postpartum depressive symptoms have serious impacts on women's lives.

"The environmental and physical and social stressors in the postpartum period are quite severe for many women," Howell tells WebMD.

Click here to read Web MD's "Preventing Postpartum Depression."

Baby Blues vs. Depression

Postpartum blues, also known as the "baby blues," affect between 50 percent and 75 percent of women after delivery. Symptoms, which include frequent, prolonged bouts of crying for no apparent reason, sadness, and anxiety, usually subside within two weeks without treatment.

Postpartum depression is a far more serious condition, affecting about one in 10 new mothers. Symptoms include alternating "highs" and "lows," frequent crying, irritability, and fatigue, as well as feelings of guilt, anxiety, and inability to care for your baby or yourself. Symptoms range from mild to severe and may appear within days of the delivery or gradually, even up to a year later. Although symptoms can last from several weeks up to a year, treatment with psychotherapy or antidepressants is very effective.

Click here to read Web MD's "Baby Blues' Don't Have to Grow to Full-Blown Depression."

Postpartum Depressive Symptoms Common

Howell and colleagues asked the women to think back to the first two weeks after they delivered their infants. They asked the women about their physical and psychological symptoms. They also asked about their daily function, the behaviors of their infants, their social support, their skill in managing their infant and their households, and their access to and trust in their health care provider.

About 47 percent of Hispanic women, 44 percent of black women, and 31 percent of white women reported postpartum depressive symptoms.

The most common factors linked to postpartum depressive symptoms were:

--Burden of physical symptoms

--Infant colic

--Social support

--Self-efficacy in managing the infant and the household

The findings appear in the June issue of Obstetrics & Gynecology.

Unlike earlier studies, the researchers did not find a woman's history of depression to be linked to postpartum depressive symptoms in the first two weeks after delivery.

"Maybe later on in the postpartum period, a woman's history of depression will predict depressive symptoms," Howell says. "But the prevalence of depressive symptoms is much higher in the first weeks after delivery."

Click here to read Web MD's "Why Seven Deadly Diseases Strike Blacks Most."

Many Races, One Path to Prevention

Regardless of a woman's race or ethnicity, Howell's team found that physical, social, and emotional stresses were linked to postpartum depression.

There were differences in how each of these factors affected black, Hispanic, and white women. But Howell and Leventhal say the similarities among the groups were even more striking.

"The depressive symptoms should not be looked at as characteristics of the people, their personalities," Leventhal says. "Some situations may be more prevalent in some racial or ethnic groups. It is not a symptom of character or biology that this happens. People tend to think of depression as being about some permanent feature of the person. But most of this is situational."

Because these situations are not uncommon, Howell says that preparing for them may be the best way to prevent postpartum depression.

"For example, lack of social support is a very important factor in postpartum depression," she says. "Mothers, before they deliver, should get help by setting up some social support. They can recruit friends, family, or even calling other mothers to ask what they went through. Many women feel isolated during this experience. Talking to people and having social support is very important."

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By Daniel J. DeNoon, reviewed by Michael W. Smith, MD

SOURCES: Howell, E.A. Obstetrics & Gynecology, June 2005; vol 105: pp 1442-1450. Department of Health and Human Services. Elizabeth A. Howell, MD, assistant professor of health policy and obstetrics and gynecology, Mount Sinai School of Medicine, New York. Howard Leventhal, PhD, professor of psychology and director, center for health beliefs and behavior, Rutgers, The State University of New Jersey, New Brunswick. WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Depression After the Birth of a Child (Postpartum Depression)."