The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care

Objective: Inconsistent diagnostic criteria fail to delineate guidelines for postpartum depression surveillance. This study evaluates the validity of commonly accepted postpartum onset criteria. Study design: Consecutive referrals to the Emory Women's Mental Health Program for evaluation of postpartum depression fulfilling criteria for major depression and taking no psychotropic medication were included. Diagnostic interview, demographics, depression scales, and the time of illness onset were obtained. Descriptive analysis was conducted for 3 participant groups: pregnancy onset, early postpartum onset within 6 weeks of delivery, and late postpartum onset. Results: Among participants, 11.5% reported prenatal onset, 22.0% late postpartum onset, and 66.5% early postpartum symptom onset. Those reporting pregnancy onset were more likely to be unmarried, and those with a late postpartum onset were less likely to report a past history of postpartum depression. Conclusion: The perinatal vulnerability to depression begins before delivery and extends beyond 6 weeks postpartum. Depression surveillance is therefore warranted during prenatal visits, at the postnatal check up, and at pediatric visits during the initial 6 months of the first postnatal year. (C) 2005 Elsevier Inc. All rights reserved.