Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety?

Although anxiety disorders are documented in the literature for new mothers (but less so for fathers), rates of postpartum caseness tend to include only those with depression when diagnostic interviews or self-report measures validated on such interviews are used. This methodology therefore underestimates the true percentage of women and men who experience significant psychological difficulties postpartum. This has implications for assessment, treatment and screening for postnatal mood disorders.

Two studies were conducted on a total of 408 women and 356 men expecting their first child. They were recruited antenatally, and interviewed at 6 weeks postpartum using the Diagnostic Interview Schedule. DSM-IV criteria were applied to determine the presence since birth of depression (major or minor), panic disorder, acute adjustment disorder with anxiety (meeting the criteria for generalised anxiety disorder except for the duration criterion), and phobia.

The inclusion of diagnostic assessment for panic disorder and acute adjustment disorder with anxiety increased the rates of caseness by between 57 and 100% for mothers, and 31-130% for fathers, over the rates for major or minor depression. Inclusion of assessment for phobia further increased the rates of disorder in both samples. Couple concordance rates were between 6.6 and 11.1%, with no significant difference between rates for depressive or depressive and anxious caseness. For women, a previous history of an anxiety disorder appears to be a greater risk factor for a postnatal mood disorder (i.e. depression or anxiety) than a history of a depressive disorder.

These results clearly show the need to assess for both depression and anxiety in new and expectant parents, and we believe the term 'postnatal mood disorder' (PMD), rather than postnatal depression, more accurately reflects significant adjustment difficulties in new parents.