PubMed · 14565742
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Carol Sakala. Resources for evidence-based practice, September-October 2003.. https://doi.org/10.1111/j.1552-6909.2003.tb00200.x
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Due to the high incidence of postpartum mental illness [postpartum depression (PPD): 10-15%], joint mother-baby treatment is the state-of-the-art, especially in Anglo-Saxon countries. The joint treatment furthermore allows the unique possibility of primary prevention for the high risk group, the children of the postpartum affected mothers, to be used. Compared to other European countries the development of German mother-baby units (MBUs) is delayed due to the higher uncovered costs of treatment, which result from treatment of the mother-baby relationship and the instructions in baby care for the mother. The committee "Qualitätssicherung in der Mutter-Kind-Behandlung" of the German section of the international Marcé-Society contacted all 470 psychiatric institutions in Germany with the goal of achieving an overview concerning the MBUs. A total of 173 institutions answered of which 83 gave an affirmative answer as far as mother-child treatment is concerned. All in all 157 treatment possibilities (134 inpatient and 24 day clinic) were recorded. From the number of treatment possibilities in England and assuming that all MBUs in Germany were recorded, only 21% of the necessary mother-child therapy places are covered.
Pediatric professionals are being asked to provide an increasing array of services during well-child visits, including screening for psychosocial and family issues that may directly or indirectly affect their pediatric patients. One such service is routine screening for postpartum depression at pediatric visits. Postpartum depression is an example of a parental condition that can have serious negative effects for the child. Because it is a maternal condition, it raises a host of ethical and legal questions about the boundaries of pediatric care and the pediatric provider's responsibility and liability. In this article we discuss the ethical and legal considerations of, and outline the risks of screening or not screening for, postpartum depression at pediatric visits. We make recommendations for pediatric provider education and for the roles of national professional organizations in guiding the process of defining the boundaries of pediatric care.
Apart from causing emotional suffering, postnatal depression strains marriage, undermines the mother's confidence, impairs her social functioning and quality of life, and in serious cases contributes to infant abuses, infanticides and suicidal behaviour. Recent studies also show that postnatal depression adversely affects emotional, behavioural and cognitive development of the newborn. In addition, there is growing awareness that depression can occur during pregnancy, and antenatal depression can adversely affect obstetric and neonatal outcomes. Antenatal depressive symptoms are also the strongest predictor of postnatal depression. This paper reviews the epidemiology, clinical presentation, risk factors, prevention and treatment of perinatal depression. The latest development in research and practice related to this condition are also highlighted.