How bad will my postpartum depression be in 12 months?

CHICAGO — A new Northwestern Medicine study was able to successfully predict if a new mother would experience worsening depressive symptoms over the first year after giving birth by identifying four maternal characteristics that put her at risk.

Identifying these factors early in the postpartum period will allow mothers to seek treatment earlier and improve their chance of a full recovery, the authors said.

The four characteristics included the number of children the mother has; her ability to function in general life, at work and in relationships; her education level, which can determine access to resources; and her depression severity at four to eight weeks postpartum. The predictions from the study were 72.8 percent accurate.

The study was published January 15 in the journal Depression & Anxiety.

“By the time a mother comes in for her six-week postpartum visit, we have the potential to predict the severity of her depression over the next 12 months,” said first author Sheehan Fisher, assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “This would be a game-changer for mothers and their clinicians because we could encourage early intervention so moms have better odds of success with their treatment over time.”

A mother with postpartum depression can fall into one of three depression trajectories, ranging from gradual remission (over time she starts to get better), to partial improvement (by 12 months postpartum, she is headed in a positive direction but continues to have symptoms), to chronic severe (her symptoms start at the same level as the partial improvement trajectory but worsen over time).

“It’s not just a question of ‘Is the mother feeling depressed?’ but rather, ‘Which way is she headed in her depression?'” Fisher said. “If her depression symptoms are going to get worse over time, she needs to be proactive about treatment.”

Fisher hopes the findings will lead to improved step care for mothers in all three depression trajectories, meaning the level of care can be tailored to each woman.

Mothers with postpartum depression typically experience difficulty sleeping, feelings of worthlessness or excessive guilt, difficulty coping with negative emotions, have an inability to focus or concentrate on things and generally feel a lot of emotional distress, Fisher said.

Postpartum depression impacts not only the mother but also can negatively impact her child’s functioning and health. It can affect the child’s emotional development, ability to regulate their own emotions and confer a higher risk for anxiety and depression.

The longer a woman’s depression goes untreated, the more difficult it is to get her back on track, Fisher said. It can also take a while to find the right medication and get access to the right provider.

“It only complicates things if the mother doesn’t start her treatment until later on,” Fisher said.

Treatment for women in the chronic severe group would differ based on the individual but could include psychotherapy and/or medication, Fisher said. Clinicians might enlist the help of the father or other family members or might seek high-level care like an intensive outpatient course of treatment for the mother.

The longitudinal study looked at data collected between 2006 and 2011 of women delivering at an academic medical center in Pittsburgh, Pa. Women with a postpartum depressive disorder participated and completed symptom severity assessments at four-to-eight weeks (intake), three months, six months and 12 months postpartum. Clinicians interviewed the women about the severity of their depressive symptoms, medical and psychiatric history, functioning, obstetric experience and infant status.

The scientists determined a woman’s score based on the four characteristics and, using a computational algorithm that predicts her depression trajectory, provided the odds of which group the woman would fall in.

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Northwestern co-authors included Dorothy Sit, Amy Yang, Jody Ciolino and Jacki Gollan. Katherine Wisner was the senior author.

Funding for this study was provided by the National Institute of Mental Health (grant R01MH071825) of the National Institutes of Health. Other Northwestern co-authors included Dorothy Sit, Amy Yang, Jody Ciolino and Jacki Gollan. Katherine Wisner was the senior author.