December 08, 2006

New Moms at Increased Risk for Mental Illness, Should be Screened After Childbirth

A new study covered in Time magazine reported this week that

"Danish researchers find that first-time mothers - but not first-time fathers - are at an increased risk for mental disorders, including schizophrenia, bipolar disorder and depression. The risk is greatest in the first three months following childbirth"

The Boston Globe, covering the same study, reported

"During the first 10 to 19 days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants. Compared with women with no children, new mothers were four times more likely to be hospitalized with mental problems."

In an age of cut-backs in medical care, especially in the area of mental health, research is backing-up the call for more screening and support of mothers following childbirth. An article in the Chicago Tribune reported on the risks of not screening, and steps New Jersey has already taken to help new mothers and their babies.

The Danish study published in the Journal of the American Medical Association, reported that within three months after giving birth for the first time, 1 out of 1,000 women suffered a psychotic disorder such as schizophrenia, bipolar disorder or depression severe enough to cause hospitalization. The article was accompanied in the journal by an editorial calling for universal screening programs that would check new mothers for these disorders.

Postpartum depression affects between 10% and 15% of mothers and their families, but the researchers said that this is an underestimate because studies have indicated that 40% to 50% of postnatal depression goes undetected. Research has shown that when new mothers suffer from depression it can have serious, long term negative impact on the brain development of the child, resulting in lower IQ and greatly increased risk of depression, anxiety and other mental illnesses in the future. When a mother gets screening, and getting early treatment for postpartum depression, experts suggest that the risk for the children getting development disorders and mental illness can be significantly reduced. For this reason, mental health screening is recommended very soon after mothers give birth.

The lead researcher of the study, Trine Munk-Olsen of the University of Aarhus noted,

"The causes of postpartum mental disorders are more strongly linked to an altered physiological process related to pregnancy and childbirth than psychosocial aspects of motherhood."

Quoted in the Boston Globe, Dr. Nada Stotland, a psychiatry professor at Rush Medical College in Chicago, suggested that many factors are likely involved in postpartum mental disorders

"Mothers generally bear the brunt of sleep deprivation, and many new mothers are socially isolated or live far from relatives who could provide support".

Dr. Valerie Davis-Raskin, a former associate clinical professor at the University of Chicago who treats patients with postpartum depression explains,

"We've had a difficult time figuring out what causes postpartum psychiatric illnesses, and I see this study as really strongly supporting a biologic, hormonal or other physical basis. All women go through this massive hormonal change after delivering a baby. It's such a stressor on the mother's brain."

This past October, New Jersey became the first state to require by law education of expectant mothers and their families about the signs of postpartum depression and the screening of new mothers for the disorder. The postpartum screening is usually done during the newborn's two-week pediatric checkup. The state of Illinois is looking to follow New Jersey's lead.

This research study on maternal mental illness (triggered by pregnancy-related hormonal stresses as well as other stresses) clarifies the need for early identification and treatment for the mother's benefit and because maternal depression greatly increases the risk of child development disorders and mental illness. The study is an example of how neuroscience research has revealed during the past decade the strongly interdependent relationship between biology, psychology and the social environment of people. Research clearly suggests that if a parent has any type of mental illness - whether it be depression, anxiety, OCD, bipolar or schizophrenia - its very important for that parent to get a good treatment as quickly as possible for their own optimal health as well as to minimize the potential negative impact on children.

An important thing to remember, for parents of children who have a mental illness already, this type of research is discussing a general risk factor for mental illness, that adds to a fundamental biological or genetic predisposition. For any given person its impossible to say, given the technology available today, exactly "what" triggered a given person's mental illness - so retroactive analysis of what caused any given person's mental illness is impossible. This information is written primarily for the people who may suspect they have a biological predisposition for some mental illness, and who is interested in lowering the risk of their children or relatives in the future.

New moms found at risk for mental illness (Boston Globe)

Time Magazine: Childbirth Linked to Mental Illness in New Moms

Chicago Tribune (5 December 2006): Psychosis hits 1 in 1,000 new moms, study says: Universal screening urged after childbirth (Free Registration Required)

Original Research: New Parents and Mental Disorders: A Population-Based Register Study

Editorial in the JAMA explaining the risks to mothers and to the development of their newborn children, and calling for universal screening of mothers following childbirth: Postpartum Depression: A Major Public Health Problem

Details: Maternal Depression and Childhood Development Disorders

More articles on pregnancy, childbirth and psychosis:

Epigenetics and Mental Illness - Child Care Has an Impact

Childcare, Genetics, Epigenetics and Schizophrenia

Prenatal Doctor's Visit may be Three Months Too Late

Tom Cruise Officially Criticized, Hubbard had Schizophrenia

Pregnancy & Schizophrenia

Scientology's War against Psychiatry

Postpartum depression - Wikipedia

Related Research:

Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. 2005, "The magnitude of the long-term effects of antenatal maternal anxiety/stress on the child is substantial. Programs to reduce maternal stress in pregnancy are therefore warranted."

Anxiety during pregnancy affects child behavior (2004)

Remember The Kids When Parents Are Ill

Depression During and After Pregnancy (National Women's Health Center)


So even though the article is saying that the mother getting the
psychotic disorder (schizophrenia) is purely biological, are
you trying to say that the reason the mother gets schizophrenia with
childbirth is actually because of a MENTAL (psychological) problem HER
mother gave her as a baby?

It sounds like you are adding a lot more to this than what the article
is saying - playing a blame game that the mother is causing something
as biological as schizophrenia. I am very disappointed with the tone
of this news blog.

I just don't understand the point of all the nasty commentary in this
news summary which should be compassionate towards the real VICTIM
here - the MOTHER who suddenly developed schizophrenia at what should
have been the happiest time of her life!

By the way - you are mixing mental illness up with a biological
illness which is severe enough to severely affect the functioning of
the brain. Just like the mother's postpartum psychosis is purely
biological and not mental, many other causes of schizophrenia also are
purely biological and not mental. We don't even know all the causes
yet of schizophrenia, so how dare you start talking about psychology,
mothers and mental health in the same breath as schizophrenia... at
least not the schizophrenia I have come to know and hate.

Posted by: Philip at December 9, 2006 01:19 PM

I don't think the article was being nasty or unsupportive to mothers.

Posted by: Tim at December 9, 2006 07:06 PM

You seem to be mis-reading the information provided and misinterpreting the intent of the article. Any mental illness impacts many other people than just the person who has the illness. For everyone's best health, research suggests that mental illness needs to treated as quickly and completely as possible.

Doctors focus to a significant degree on raising awareness and the need for treatment of postpartum disorders (postpartum depression, postpartum psychosis, etc.) because children's brains are extremely sensitive to the social/emotional environment they experience during the first few years of their life. Postpartum mental illnesses by mothers are well known (see the links in the main article) to cause life-long brain impacts in the child and increase the risk significantly for mental illness.

The point is not to lay blame on anyone - but rather to raise awareness and thereby increase actions for prevention. Research suggests that the impact of Mental illness in parents can continue on from generation to generation (not only due to biological predisposition, but also due to social and emotional environmental factors that are preventable).

We encourage you to read all the links provided in the article to gain a better understanding in this area.

Posted by: szadmin at December 9, 2006 08:34 PM

Philip, the original article was supportive of the patient with psychosis, and did not imply that there was any cause to the postpartum psychosis other than biological. Even without the presence of a baby in the picture, it would be nice to think that society would be just as concerned and caring about the - as you put it - the victim - herself. Of course, the unfortunate reality of our society is that we have shown less compassion for the victims of psychosis than society has shown fear about the damage to others that might be done by that victim.

You, yourself, show that you are a kind, compassionate, and caring man by your concern about the mothers, and possible stigma towards them.

Posted by: Jeanie at December 10, 2006 10:03 AM

I felt uncomfortable with my name appearing with this news posting, and I wish to address the feedback. The news summary I posted started off being a simple summary of the research about childbirth triggering neurobiological brain disorders in many new mothers, the call for doctors and families to be aware that this can happen, and that it is so imperative that mothers be screened for these disorders following childbirth that states have begun mandating the screening by law. Because of the research showing that early psychological stress can harm the baby’s brain, and since a mother in a psychotic state can be a significant stressor, the site administration added information about the negative effects poor care can have on babies. Some people felt that I was insensitive for the resulting post, saying that they felt that the message being given was that all mental illness was preventable and that the mother caused it, and it detracted from the message of empathy for the person with schizophrenia. I apologize. The two parts of the news post were really just that – two parts. One was about the research on childbirth affecting women, and the other was research about affected women affecting babies.

The administration of this site’s emphasis is on doing everything possible to mitigate the occurrence of all the forms of mental illnesses (not just schizophrenia) that are triggered by psychological, nutritional, chemical, and other stressors pre-natally as well as in infancy and childhood. Although it is talked about as “prevention”, of course protecting children and not exposing them to maternal depression cannot prevent neurobiological brain disorders, but it might prevent those cases of disorders that are caused by people (children and adults) surviving severe emotional and psychological stressors. In addition, in any illness, not just ones involving the brain, stressors can exacerbate it.

I was quickly bombarded by protests over this news blog item by mothers, sons, daughters and others who know me. They felt attacked and emotionally stressed by the combination of research into postpartum psychosis and what felt like “this illnesses could have been prevented if only…” or “your mother caused this in you…”, especially coming on the heels of the “Is it Psychological or Biological?” discussion. The parents coming to this website have been loving, intelligent, caring, nurturing, and protective of their children since day one. Some mothers diagnosed with schizophrenia had a wonderful childhood and life until after the postpartum illness.

Another concern raised was that so much emphasis on psychology is harmful to trying to seek insurance parity for these disorders. Parents are trying to get the illness taken out of the realm of “mental” and into the realm of “medical”. Psychology can affect cancer, lupus, diabetes, autism, epilepsy, allergies, narcolepsy, viral infections, bacterial infections, heart disease, etc. but we do not call these mental, nor do we continually dwell on psychological means of prevention from infancy. However, as “szadmin” pointed out, psychology does affect biology. We are just very sensitive about this because schizophrenia is called “mental” when these others are not, and we don’t see the families of people with other illnesses being bombarded by talks about mental preventatives.

One reason may be that science has not advanced enough to separate out the cases of psychosis that are caused by developmental or infectious assaults creating problems with neuropsychiatric hormones resulting in the psychosis, from other cases for whom the psychosis might be a result of their own personality or mental state or mental disturbances. I am on the side that schizophrenia should not be treated as a “mental” disorder, but rather, as “medical”, but apparently research is showing that some cases are due to “mental” problems. What is sad about this is that so many people are being deprived of appropriate care because all cases for now are being classified as “mental".

No doubt - This is a complicated topic.

Posted by: Jeanie at December 11, 2006 09:55 AM

I can relate to this article as my mother's sz was,in my opinion, triggered by the birth of her first child, and the next two births brought on subsequent relapses.

In these circumstances i dont think there is ever just one victim, but many people who are affected by the illness in different ways. It is extremely difficult as a small child to watch your parent reject your new born sibling and to try to step in where she will not.

It is a huge fear of mine that if i have a child i will develop sz. I have escaped it 'til now while having encountering almost every possible risk factor. I hope pregnancy and birth would not be the one to tip me over as i could never face putting a child through what we went through.

In conclusion, more funding into mothers all over health during and after pregnancy would only be hugely benefitial to mother and to baby.

Posted by: G at January 12, 2007 02:04 AM

My husband has two children from his previous marriage. His ex-wife had a pretty severe diagnosis of bi-polar disorder since puberty, and he did not know any of this history until the birth of their first child landed her in hospital five months later for trying to kill herself and the baby. She was committed and spent a few months in-patient,diagnosed as paranoid schizophrenic, then released due to insurance "fulfillment". They reconciled and another baby later and 6 more attempts at her life they divorced. Even given her medical or mental history, the courts awarded custody of children to her. Since the day she was released, she stopped all treatment, and has been torturing these kids via her illness ever since. The courts are extremely biased toward the mother as primary caregiver, but 6yrs later we have finally won sole custody, giving her supervised visitation only. This might seem harsh to you, but think of these kids growing up watching their mother getting arrested constantly at their schools, violently attacking every family member including the kids themselves, and growing up as your mom's caregiver since you could talk. Imagine as a kid having an average of 50 to 70 absences from school because you couldn't get there as your mom is in jail again, terrified to tell anyone because of lies she tells you will happen due to her delusions. Imagine going to 2nd grade with blue hair one day because your mom woke you up at 3am, dyed your hair while crying because it will protect you from ghosts? This is the torture my step-children are just now beginning to overcome. If the laws in my state were similar to those of New Jersey for instance, I don't believe these kids would have to have lived in these conditions and worse for as long. I understand depression does not make you a neglectful mother, but I am talking about schizophrenia here!! Where are the rights for these innocent babies that have to survive caring for their severely ill mother or father????

Posted by: Sarah at February 8, 2007 02:54 AM

parents can be good no matter they suffer from schizophrenia. not fair to be judge on all people with a condition. bad parents there are with no schizophrenia. my pater good with illness still good. he has good medication and his condition much improved. mother was kind to him.

Posted by: Zieg at February 12, 2007 02:15 PM

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