Literature review for - Flourish Paediatrics

normal functioning (Horowitz and Goodman 2005). Moreover, the presence of four or more
of the additional symptoms is required for a diagnosis: significant weight loss when not
dieting, weight gain, change in appetite, insomnia, hypersomnia, psychomotor agitation, and
retardation almost every day is required for a diagnosis (Horowitz and Goodman 2005).
The Edinburgh Postnatal Depression Scale (EPDS)
In recognition of the importance of diagnosing postnatal depression The Edinburgh Postnatal
Depression Scale has been included in previous editions of the Infant Feeding Guidelines for
Health Workers. The Edinburgh Postnatal Depression Scale EPDS (Cox, Holden et al. 1987)
is a reliable, valid, ten item tool which can be administered easily and is developed to
specifically screen for postpartum depression.
Risk factors for postnatal depression
Determining the predisposing factors for postpartum depression is important so women at
risk of developing depression can be identified early and the appropriate preventative
strategies can be put in place. A meta-analysis of 44 studies found that ‘prenatal depression’,
‘child care stress’, ‘life stress’, ‘social support’, ‘prenatal anxiety’, ‘maternity blues’, ‘marital
satisfaction’, and ‘history of previous depression’ are predictor variables of postnatal
depression (Beck 1996). Several other meta-analyses have found that factors with moderate
to strong association with postpartum depression include ‘depression and anxiety during
pregnancy’, ‘postpartum blues’, ‘previous history of depression’, ‘stressful life events’, ‘a
poor marital relationship’, and ‘poor social support’ (O'Hara and Swain 1996; Beck 2001;
Robertson, Grace et al. 2004; Jones, Scott et al. 2010). Other risk factors such as ‘low
socioeconomic status’, ‘obstetric factors’, and ‘difficult infant temperament’ were found to be
less strongly related to postpartum depression (Beck 2001; Robertson, Grace et al. 2004).
Postnatal depression and growth faltering in infants
Several studies conducted in developing countries have reported an association between postnatal
depression and infant growth impairment. A critical review of 11 studies from UK,
India, Pakistan, South Africa, Ethiopia, Jamaica, Brazil, Peru, and Vietnam, by Stewart
found postnatal depression was associated with growth faltering in developing countries but
not in developed countries (Stewart 2007). Stewart provides four possible explanations for
the relationship between maternal postnatal depression and infant growth faltering and
discusses possible reasons for the discrepancy between countries.
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