Fatigue May Be Red Flag For Postpartum Depression

A simple questionnaire on fatigue, administered two weeks after birth, may serve to identify women who at increased risk of developing moderate to severe postpartum depression, according to researchers.

"Postpartum depression affects up to 15 to 20 percent of new mothers," says Dr Elizabeth Corwin, assistant professor, School of Nursing at Penn State. "It comes on anywhere from two weeks to four months after childbirth and may last from two weeks to a year."

The researchers note that 50 to 80 percent of new mothers will have postpartum blues. However, this very common malady is mild and usually goes away on its own, although occasionally, postpartum blues can become postpartum depression. Less than a half percent of new mothers will develop postpartum psychosis, a very rare and very dangerous mental illness.


Looking for a connection
Corwin and Ingrid Bozoky, a recent master's degree recipient, wanted to see if a connection between postpartum fatigue and postpartum depression exists. The researchers visited mothers recruited from Centre Community Hospital in State College, Pennsylvania, within 24 hours after they gave birth and then at 7, 14 and 28 days after their babies were born. As part of a larger study on immune system activation, the researchers collected urine samples, administered a simple, standard questionnaire about fatigue and on day 28, administered a standard questionnaire on depression.

"Women with high levels of fatigue on days 7 and 14 were significantly more likely to report symptoms of depression on day 28, than women with low levels of fatigue," Bozoky told attendees at the Scientific Session of the Eastern Nursing Research Society in March 2002 in University Park, Pennsylvania.

The simple 20-question questionnaire pinpointed 93 percent of the women who would suffer moderate to severe depression on day 28 using a cutoff score of 6 on the fatigue questionnaire. "A simple questionnaire used on day 14 after birth, which would correspond with one of the baby's first visits to the pediatrician or other health care provider, could serve as a screening tool to identify women likely to develop postpartum depression," says Corwin. The researchers did find five women whose answers to the questionnaire indicated they were at risk of developing postpartum depression, but these women did not suffer depression. Beyond what's "normal"
"Fatigue after childbirth is normal, and those women who did not report depression at 28 days showed a steady decline in tiredness during the first month after delivery," says Corwin. "The women who did show moderate to severe postpartum depression did not experience a fall off in fatigue as time progressed."

The study found that the choice of breast or bottle-feeding had no effect on who became depressed. Neither did the presence nor absence of other children or partners. None of the women had been diagnosed previously as having suffered postpartum depression, but it was unknown if the women had suffered previous undiagnosed bouts of generalized depression. There were 38 women in the study and 14, or 36 percent, showed moderate to severe depression.

Corwin plans to repeat the study with a larger group of women and to include both rural women and women of color. She will also determine if subjects suffered any incidents of depression before childbirth or undiagnosed depression after a previous birth. Other factors to be included are stress levels and sleep quality. "In the 1980s, people talked about the role of fatigue in depression, but we do not know if fatigue simply predicts depression or causes depression," says Corwin. "There certainly is some connection between fatigue and postpartum depression.

"Mothers should remember that they need to take care of themselves after giving birth; fatigue is common and may play a role in postpartum depression."PregnancyAndBaby.com

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