Postpartum mood crises

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F53.– Mental or behavioral disorders associated with the puerperium, not elsewhere classified
F53.0 Mild psychological and behavioral disorders in the puerperium, not elsewhere classified
postpartum depression
F53.1 Severe psychological and behavioral disorders in the puerperium, not elsewhere classified
puerperal psychosis
F53.8 Other postpartum mental and behavioral disorders, not elsewhere classified
F53.9 Mental disorder in the puerperium, unspecified
ICD-10 online (WHO version 2019)

Postpartum mood crises (from Latin partus birth, childbirth) describe mental states or disorders that occur in a temporal connection with the puerperium (Latin post = after; partus = childbirth, separation). The spectrum of affective states occurring in the puerperium ranges from a slight sadness to depression to severe psychotic illnesses. Women are mostly affected, but more recent research has also reported postpartum depression in men.

So far, a distinction has been made roughly between three types of postpartum disorders, which often flow into one another:

  • the postpartum mood low (colloquially baby blues or crying days ),
  • the postpartum depression (PPD), also postnatal depression (born from lat. natus ), and the
  • Postpartum Psychosis (PPP).

Postpartum mood low

The postpartum low mood, also known as "baby blues", is the mildest form of the disease . This is a mild, short-term state of disgruntlement in the first few weeks after the birth, which usually subsides within hours to days.

In addition to the subdepressive mood, the baby blues is characterized by pronounced mood lability, sadness, frequent crying, general irritability, excessive worry (mostly about the child), exhaustion, anxiety, irritability, appetite disorders, sleeplessness and restlessness, and difficulty concentrating. As a rule, baby blues are not considered to be disease-related and will go away on their own.

This mild postpartum mood is very common. In the DSM-IV , baby blues is specified as a temporary phenomenon that affects 70% of all women who have recently given birth, is not classified as disease-related and must be distinguished from the postpartum affective episode. The figures vary between 25% and 80% in different studies; this range of variation is primarily related to methodological differences between the various studies. What is certain is that in the first week after giving birth, dysphoric discomfort occurs four times more often than in a control group of women without giving birth.

Many experts describe the baby blues as a healthy reaction to the complex changes caused by childbirth and motherhood. But there are also behavioral researchers who argue that the baby blues do not occur in many so-called " primitive peoples " and that it is a consequence of the interventions of modern industrial society around childbirth, since it makes it impossible to get to know mother and child undisturbed.

The information on which factors favor baby blues are very inconsistent. The risk seems to be higher if there is a history of depressive illness and little social support. The mode of birth does not seem to play a role. The frequency in women who gave birth by caesarean section does not differ from that of women who gave birth spontaneously, and the place of birth does not seem to play a role either. Only women who had to abort a planned out-of-hospital birth had a significantly increased baby blues rate, which can be explained by the fact that the woman giving birth was unable to put her ideal ideas into practice and this leads to disappointment and feelings of failure.

The main cause of the baby blues seems to be the hormonal change after the birth - the greatly increased estrogen during pregnancy - and progesterone levels drop with the birth of the placenta and prolactin increases. It is believed that estrogen influences various brain functions and has a mood-stabilizing, antipsychotic effect; this effect now disappears and may lead to a drop in mood. This also explains similar phenomena in connection with the menstrual cycle ( premenstrual syndrome ) and menopause .

Postpartum Depression (PPD, Postpartum Depression)

PPD can develop at any time during the first two years after giving birth. A gradual development is typical of the PPD; it is usually only recognized on the basis of physical symptoms. 10–20% of mothers are affected by PPD; around 4% of fathers also suffer from PPD after giving birth. Risk factors for the development of postpartum depression include mental illnesses before pregnancy (especially depression , obsessive-compulsive disorder , panic disorder , generalized anxiety disorders , social phobias , agoraphobia ), mental illnesses that have occurred in close relatives, traumatic experiences and stressful life situations such as financial poverty , social isolation or poor quality or support in the partnership .

Characteristics of the PPD are lack of energy, sadness, inner emptiness, feelings of guilt, ambivalent feelings towards the child, general disinterest, apathy, hopelessness, thoughts of killing (related to oneself, to the child and / or other family members), sexual aversion, headaches, heart problems, extreme irritability, numbness, tremors, dizziness, difficulty concentrating and sleeping, anxiety and panic attacks .

Obsessive-compulsive thoughts occur in 54% of women with postpartum depression.

Postpartum anxiety can be seen as a separate category, as various anxiety disorders do not necessarily mean depression. They occur in the first two to three weeks and include severe, recurring feelings of fear and / or panic, mostly related to the baby's well-being. Untreated anxiety can lead to depression .

Postpartum depression is in urgent need of treatment because of the risk of suicide (suicide). Inpatient treatment may be necessary.

Extremely rarely (according to a study 1–2 per 100,000 depressed mothers), mothers with PPD commit the so-called infanticide , i. that is, they kill their own child. The so-called neonaticide , the killing of the newborn immediately after birth, on the other hand, is not related to postpartum depression according to current knowledge.

Postpartum Psychosis (PPP)

The puerperal psychosis or paranoid-hallucinatory puerperal psychosis is the most serious psychiatric complication in the puerperium. It usually has an abrupt start and should immediately lead to an emergency admission to a psychiatric clinic. The severe paranoid-hallucinatory symptoms with states of anxiety, excitement and confusion have a more favorable prognosis than psychotic illnesses at another point in life. It can come to a complete healing, but similar to the manic-depressive illnesses can take a phasic course. According to the ICD-10, most of these postpartum psychoses can be classified diagnostically as acute polymorphic psychotic disorders.

One to three in 1000 mothers (1–3 ‰) are affected by postpartum psychosis (PPP). PPP mainly develops in the first 2 weeks after delivery or can develop from depression.

Mixed forms

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

The three forms of PPP often show up as mixed forms with other states:

Mania : There is a strong increase in drive, motor restlessness, confusion, megalomania, high mood with euphoria, disinhibition and a reduced need for sleep. In these cases, a risk results from improper handling of the child or a disruption of general judgment.

Depression : Anxiety, lack of drive, immobility and indifference are expressed.

Schizophrenia : Shows up through hallucinations and delusions, believing that the woman is hearing voices or seeing things that do not exist.

causes

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

The causes of a postpartum mood crisis are explained multifactorial, the factors can have different weightings.

Evolutionary function

According to evolutionary biologists, postpartum mood crises are consistent with the theory of parental effort . You could signal to the mother that she is about to lose fitness , for example if the circumstances are unfavorable. In addition, the mother's crises could help to get support with parenting expenses.

Biological causes

  • The great physical exertion during childbirth (⇒ physical exhaustion);
  • The sudden physical change in the abdomen, breasts, metabolism and digestion after childbirth;
  • The possible (im) balance of hormones : the sudden drop in progesterone levels can cause feelings of depression, and the drop in estrogen levels can lead to significant sleep disorders.
  • A lack of thyroid hormones (underactive) can also lead to depressive symptoms or anxiety and panic attacks after the birth. The autoimmune disease Hashimoto's thyroiditis often breaks out after birth (for example as postpartum thyroiditis ) and leads to an underactive thyroid with its symptoms of weakness, fatigue and exhaustion, depression, etc. An overactive thyroid can also lead to anxiety and panic attacks. It is usually triggered by the autoimmune disease Graves' disease, which can also break out postpartum.
  • Women with premenstrual syndrome (PMS, irritability caused by hormonal changes) are more likely to get PPD than women without PMS. (Note: There is also a statistical relationship between PMS and borderline personality disorder ; this in turn generally correlates with mood crises and depression.)

Mental causes

  • Childbirth can confront a woman with her fears (such as fear of failure or fear of pain), her imperfection (see perfectionism ) and / or an unrealistic and exaggerated image of the mother.
  • Birth can also mean that the woman has to say goodbye to her own childhood; Any remaining deficits or unprocessed experiences make this process more difficult.
  • New social structures can be perceived as psychological stress; was the woman z. For example, if you previously worked and now stays at home as a mother, this can be perceived as isolation.

Women with a strong need for control , pronounced perfectionism or those who have previously experienced panic attacks or depression are more at risk.

Psychosocial causes

They are particularly based on the image of the mother, that of the "young mother" (= the woman with a postpartum mood crisis ). was conveyed (especially in childhood and adolescence) or that she internalized. The mother image contains (implies)

  • Expectations the young mother has of herself, and
  • Young mother's guesses as to what third parties expect of her.

To these two aspects of the mother image contribute u. a. the environment (parents, siblings, relatives, friends), the upbringing (by parents, school, possibly religious institutions) and cultural influences (e.g. advertising, films, literature). It is not uncommon for women to feel unable to cope with the image of an always perfect, always happy mother. B. if problems arise with breastfeeding the child. The women come under psychological pressure, which results from the perception of not meeting their own and other people's expectations of the situation.

Postpartum symptoms can also occur in men, but these are often not taken seriously and / or not recognized.

Cultural influences

A comparison of 143 studies with data from 40 countries showed that the actual incidence of PPD ranged from 0 to 60%, which has been associated with large socio-economic differences. The frequency was very low in Singapore, Malta, Malaysia, Austria and Denmark, but very high in Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea.

Abuse / rape experiences

They represent massive traumatic life experiences. Research results show that retraumatisation through pregnancy and childbirth is possible for survivors . Retraumatisation can exacerbate the three causes mentioned above (biological, psychological, psychosocial). Retraumatized mothers are more likely to have postpartum problems than other mothers.

A high number of unreported sexual offenses is suspected.

Other connections

There could be other biological, psychological, or cultural factors that influence the likelihood of post partum depression (PPD).

Two small studies (i.e. based on a few cases) found that in France this probability is higher if the newborn is male, while in China it is higher if it is female. The number of cases on which these studies are based is small, however, and associations with other factors cannot be ruled out.

Relief efforts

The prognosis for the vast majority of mental illnesses after childbirth is very good. The time until recovery is usually associated with great suffering for the sick mother. In this situation, affected women can often no longer believe that the depression will completely subside in almost 100% of all those affected. This hopelessness is a symptom of depression; it can be exacerbated by a lack of education and / or specific competent professional support.

Professional help

Self-help can be used in conjunction with moderate depression. Help from partners, family and friends or professional support with housework and baby care (from family carers ) can also have a positive effect.

Self-help alone is often not enough, so professionals should be consulted. In the case of severe postpartum depression or even psychosis, immediate professional help is absolutely necessary. In some cases, hospitalization is also required to protect the lives of both mother and child. Among other things, the following professional treatment options, which can be combined with one another, are available: psychotherapy , systemic family therapy , music therapy , art therapy , psychopharmacotherapy, hormone therapy, naturopathic therapy, inpatient treatment.

There are special outpatient clinics for postpartum mental disorders. One example is the “mother-child outpatient clinic for postpartum mentally ill mothers” at the LWL Clinic in Dortmund . Such a special outpatient clinic can refer mothers to inpatient treatment. For example, mothers and their up to one year old child can be accepted into the mother-child unit at the Westphalian Center in Herten .

In 2018, NHS England also introduced professional support for partners of mothers with postpartum mood crises and assessed this as a radical innovation.

Others

The film “ Herbstkind ” from 2012 addresses a postpartum mood crisis: a midwife (played by Katharina Wackernagel ) is looking forward to preparing for the arrival of her first child. The home birth has to be canceled, the midwife comes to a clinic. From the first moment she senses that she cannot love this child; in her home in a Bavarian village she suddenly feels as if she has fallen out of the world. Much is alien to her, e.g. B. Her happy mother-in-law, her neighbor and her loving husband, for whom life with a wife, child and church choir could actually be perfect.

The subject of “postpartum depression” is also dealt with in the film “ The Stranger in Me ” from 2008.

See also

literature

  • Pascale Gmür: Mother Souls Alone. Postpartum exhaustion and depression . Pro Juventute Verlag, Zurich 2000, ISBN 3-7152-1013-3 .
  • Petra Nispel: Mother's happiness and tears. Overcoming the emotional depression after the birth . Herder, Freiburg im Breisgau 2001, ISBN 3-451-05207-5 .
  • K. Thies: Actually, I should be happy. Mental crises after childbirth. In: Forum: Women and Society. Volume 1, 1997, pp. 14-21.
  • Carol Dix: Actually, I should be happy: Help and self-help with postnatal depression and exhaustion . Kreuz-Verlag, Zurich 1997, ISBN 3-268-00047-9 .
  • Brooke Shields : I would love to love you so much. About the great sadness after giving birth . Schröder, Munich 2006, ISBN 3-547-71104-5 .
  • Sylvia Börgens: The child is here, happiness is a long time coming . Mabuse, Frankfurt am Main 2012, ISBN 978-3-86321-034-2 .
  • Ulrike Schrimpf: How can I hold you if I break myself? My postpartum depression and the way back to life . Südwest Verlag, 2013, ISBN 978-3-517-08906-5 .
  • Anke Rohde: Postnatal Depression and Other Psychological Problems: A Guide for Affected Women and Relatives. Kohlhammer, Stuttgart 2014, ISBN 978-3-17-022116-1 .

Web links

  • Familienplanung.de - Even fathers have lows  : The information portal of the Federal Center for Health Education (BZgA)

Individual evidence

  1. ↑ The partus (Latin) is the medical term for childbirth. Pre-, peri- and postpartum refer to the mother's situation before, during and after the birth. The natio (lat.) Is the birth of the child. Postpartum illness = illness of the mother; postnatal disease affects the newborn.
  2. ↑ M. Lanczik, IF Brockington : Postpartum mental illnesses. In: Dt. Medical journal. Volume 94, 1997, pp. A-3104-3108.
  3. ↑ Psychology - Fathers also get depressed after giving birth. on: Spiegel Online. May 18, 2010.
  4. ↑ Anita Riecher-Rössler : The depression in the postpartum period. In: U. Demal, H. Katschnig, CM Klier (eds.): Mother happiness and mother suffering. Diagnosis and therapy of postpartum depression. Facultas, Vienna 2001, p. 24.
  5. ↑ H. Saß, H.-U. Wittchen, M. Zaudig, I. Houben: Diagnostic and statistical manual of mental disorders. Text revision - DSM-IV- TR. Hogrefe, Göttingen 2003.
  6. ↑ MW O'Hara, EM Zekoski, LH Phillips, EJ Wright: Controlled prospective study of postpartum mood disorders: comparison of childbearing and non-childbearing women. In: Journal of abnormal Psychology. 1990, pp. 3-15.
  7. ^ B. Salis: Mental disorders in the puerperium. Possibilities of midwifery. Elsevier Urban & Fischer, Munich, p. 4.
  8. ^ MW O'Hara: Postpartum Depression. Causes and Consequences. Springer-Verlag, New York 1995.
  9. ↑ F. Gröhe: Take it away from me. Depression after having a baby. Vandenhoeck & Ruprecht, Göttingen 2003.
  10. ^ A. Gregoire: Estrogens and Perinatal Disorders. In: N. Bergemann, A. Riecher-Rössler (Ed.): Estrogens Effects in Psychiatric Disorders. Springer, Vienna 2005, pp. 191–207.
  11. ↑ A. Riecher-Rössler: What is postpartum depression. In: B. Wimmer-Puchinger, A. Riecher-Rössler (eds.): Postpartum Depression. From research to practice. Springer, Vienna 2006, pp. 11–21.
  12. ^ A. Gregoire: Estrogens and Perinatal Disorders. In: N. Bergemann, A. Riecher-Rössler (Ed.): Estrogens Effects in Psychiatric Disorders. Springer, Vienna 2005, pp. 191–207.
  13. ^ The Lancet. Volume 56.
  14. ↑ Idealized image of the mother instead of reporting on postnatal depression. www.derblindefleck.de with sources.
  15. ↑ Lee Baer: The Imp of the Mind. Penguin Books, Plume, pp. 20ff. and p. 140.
  16. ↑ Luc Turmes: Inquiry about pregnancy, childbirth and early childhood development. Vienna, April 2008.
  17. ↑ S. Oddo, A. Thiel, D. Klinger, J. Würzburg, J. Steetskamp, ​​C. Grabmair, F. Louwen, A. Stirn: Postpartum Depression: An Interdisciplinary Therapy and Research Approach . In: Journal of Gynecological Endocrinology. Volume 18, No. 3, 2008, p. 12.
  18. ↑ Infanticide: "Women see their child as a disturbing object". Interview with Theresia Höynck in Spiegel Online . April 28, 2012.
  19. ↑ M. Lanczik, IF Brockington: Postpartum mental illnesses. In: Dt. Medical journal. Volume 94, 1997, pp. A-3104-3108.
  20. ^ The Functions of Postpartum Depression. (PDF; 175 kB)
  21. ↑ Edward H. Hagen, H. Clark Barrett: Perinatal Sadness among Shuar Women. In: Med Anthropol Q. Band 21 , no. 1 , March 2007, p. 22–40 ( itb.biologie.hu-berlin.de ( memento from September 26, 2007 in the Internet Archive ) [PDF; 116 kB ]).
  22. ↑ U. Halbreich, S. Karkun: Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. In: Journal of affective disorders. Volume 91, number 2-3, April 2006, pp. 97-111, doi: 10.1016 / j.jad.2005.12.051 . PMID 16466664 (Review).
  23. ↑ Male births are more likely to reduce quality of life and increase severe post-natal depression. February 13, 2008, accessed June 28, 2008 .
  24. ↑ In China, Women Who Give Birth to Girls Face An Increased Risk of Postpartum Depression . In: International Family Planning Perspectives . tape 33 , no. December 4 , 2007 (English, guttmacher.org [accessed June 28, 2008]).
  25. ↑ Does motherly happiness come automatically? (PDF; 164 kB) (No longer available online.) Archived from the original on February 1, 2012 ; Retrieved June 28, 2008 .
  26. ^ NHS to introduce mental health checks for new fathers. In: The Guardian. December 2, 2018, accessed August 3, 2019 .
  27. ^ ARD, first broadcast October 24, 2012 ( memento of October 26, 2012 in the Internet Archive )