Mental illness : relation to childbirth and experience of motherhood

Abstract

This thesis comprises two population-based studies of mental illness in childbearing women in Stockholm.

The principal aims in study I were to find out to what extent postnatal depression (PND) in mothers was identified at Well-Baby Clinics (WBCs) and to study its prevalence using the Edinburgh Postnatal Depression Scale (EPDS). The positive predictive value of the EPDS against an interview-based Research Diagnostic Criteria (RDC) diagnosis of depression was tested and sociodemographic risk factors for PND were evaluated.

In study II the principal aims were to study the prevalence of personality disorders (PDs) and elucidate the importance of PDs, sociodemographics and health-related factors for the development of psychiatric symptoms in primiparous women. The importance of PDs and psychiatric symptoms during pregnancy as well as obstetrical factors for women s experiences of childbirth was investigated. Finally, the importance of PDs and psychiatric symptoms during pregnancy and childbirth experiences for women s experience of motherhood was studied.

In study I, case-records of 1128 infants were reviewed at WBCs to obtain a baseline rate of PND. Two per cent of the mothers were identified by the nurse at the WBC as depressed during the first 3 months post partum. In a second phase of the study, 309 mothers completed the EPDS questionnaire 3 months post partum. In total, 14.5% of the women scored >12 points on the EPDS. Sixty-seven per cent of these women had a depression according to the RDC. At least 8.4% of the mothers had a clinical depression. To be single and to be multiparous were significantly associated with PND.

In study II, 625 primiparous women were assessed during pregnancy, three and 18 months post partum using The Symptom Checklist-90, the modified SCID screen and the Global Assessment Functioning Scale. At three and 18 months post partum the Maternal Adjustment and Maternal Attitude questionnaire was added. Two weeks after childbirth visual analogue scales for childbirth experiences were filled in. Obstetrical and neonatal case-records were scrutinised. The prevalence rate of PDs during pregnancy was 6.4%. PD was strongly associated with psychiatric symptoms during and after pregnancy and also with long-lasting psychiatric symptoms. Psychiatric caseness during pregnancy was strongly associated with psychiatric caseness post partum.

Socio-economic status, to be younger and previous treatment for mental problems were identified as risk factors for psychiatric symptoms. Obstetric factors such as instrumental delivery and epidural analgesia were of greater importance for negative birth experiences than mental illness during pregnancy. The process of adjustment to motherhood was impaired in women with mental illness during pregnancy. PD was as negative for adjustment to motherhood as psychiatric symptoms. The impact of a negative birth experience on adjustment to motherhood tends to diminish over time.