Hormonal and physical changes, personal and family history of depression, and the stress of caring for a new baby all may contribute to the development of postpartum depression.Evidence suggests that hormonal changes may play a role. Understanding the neuroendocrinology characteristic of PPD has proven to be particularly challenging given the erratic changes to the brain and biological systems during pregnancy and postpartum. A review of exploratory studies in PPD have observed that women with PPD have more dramatic changes in HPA axis activity, however directionality of specific hormone increases or decreases remain mixed. Hormones which have been studied include estrogen, progesterone, thyroid hormone, testosterone, corticotropin releasing hormone, endorphins, and cortisol. Estrogen and progesterone levels drop back to pre-pregnancy levels within 24 hours of giving birth, and that sudden change may cause it. Aberrant steroid hormone–dependent regulation of neuronal calcium influx via extracellular matrix proteins and membrane receptors involved in responding to the cells microenvironment might be important in conferring biological risk. The use of synthetic oxytocin, a birth-inducing drug, has been linked to increased rates of postpartum depression and anxiety.Fathers, who are not undergoing profound hormonal changes, can also have postpartum depression. The cause may be distinct in males. Profound lifestyle changes that are brought about by caring for the infant are also frequently hypothesized to cause PPD. However, little evidence supports this hypothesis. Mothers who have had several previous children without experiencing PPD can nonetheless experience it with their latest child.
Current studies estimate the prevalence to be 15-25% but this is likely higher due to a lack of data and recorded cases. The magnitude of postpartum depression in South Africa is between 31.7% and 39.6%, in Morocco between 6.9% and 14%, in Nigeria between 10.7% and 22.9%, in Uganda 43%, in Tanzania 12%, in Zimbabwe 33%, in Sudan 9.2%, in Kenya between 13% and 18.7% and, 19.9% for participants in Ethiopia according to studies carried out in these countries among postpartum mothers between the ages of 17–49. This demonstrates the gravity of this problem in Africa, and the need for postpartum depression to be taken seriously as a public health concern in the continent. Additionally, each of these studies were conducted using Western developed assessment tools. Cultural factors can affect diagnosis and can be a barrier to assessing the burden of disease. Some recommendations to combat postpartum depression in Africa include considering postpartum depression as a public health problem that is neglected among postpartum mothers. Investing in research to assess the actual prevalence of postpartum depression, and encourage early screening, diagnosis and treatment of postpartum depression as an essential aspect of maternal care throughout Africa.Issues in Reporting Prevalence
Most studies regarding PPD are done using self-report screenings which are less reliable than clinical interviews. This use of self-report may have results that underreport symptoms and thus postpartum depression rates. History
Prior to the 19th century
Western medical sciences understanding and construction of postpartum depression has evolved over the centuries.