Dimensions of postpartum psychiatric distress: preliminary evidence for broadening clinical scope

Perinatal psychiatric disturbances afflict a significant number of women sometimes with tragic consequence. Yet, the range and characteristics of these disturbances are poorly understood. The goals of this research were to characterize a broader range of postpartum psychiatric symptoms and to identify their inherent structure using exploratory factor analysis (EFA).

An Internet-based survey with 142 Likert-type questions, covering nine dimensions of postpartum mental health was constructed and posted on women's health websites. Data collected from 215 respondents was analyzed in three steps: (1) inter-item correlations were used to reduce the total number of variables by eliminating items that provided redundant information; (2) an EFA using a principal components extraction and VARIMAX rotation was performed and factors loading with Eigenvalues >1.0 were retained; (3) internal consistency was measured with Cronbach's alpha.

The 10 factors retained accounted for 58% of the variance and included: mental status (28%), psychoticism/morbid thoughts (6%), generalized anxiety (6%), panic (3%), guilt/self-criticism (3%), compulsive behavior (3%), hyper-vigilance (2%), contentment (2%), negative body-image (2%), and manic behavior (2%). There was strong (>0.8) internal consistency in all but the mania factor (0.6).

The study was retrospective and respondent demographics were homogeneous.

Postpartum psychiatric disturbances are not limited to depressive symptoms. In the current study, cognitive difficulties, psychotic-morbid thoughts and anxiety symptoms accounted for the preponderance of variance while depressive symptoms did not form a cohesive factor and accounted for minimal variance. These results suggest postpartum screening tools should assess a broader array of symptoms.