Women's/Infant's Health

Clinical Depression

• studies consistently show higher rates of depression among women

  • the female to male ratio averages 2:1

  • about 5% of Canadians 15+ report symptoms of depression in the previous year

Major Depression

• depressive symptoms occurring for at least 2 weeks (5 or more, at least one of which is depressed mood)

  • persistent loss of interest in daily activities**

  • persistent feeling sad or down**

  • sleeping problems

  • trouble concentrating

  • unintentional weight gain or loss

  • irritability

  • feeling fatigued or weak

  • low self-esteem

  • loss of interest in sex

  • thoughts of suicide or suicidal behaviour

  • unexplained physical problems

2 screening questions that could be asked to catch the risk of depression

• over the last 2 weeks have you felt down, depressed, or hopeless?

• over the last 2 weeks have you felt little or no interest or pleasure in doing things?

Diagnosis of Depression

• when diagnosis is suspected, a battery of medical and psychological tests and exams are typically run

• these tests can help rule out other problems that can be causing the symptoms

  • vitamin D deficiency

  • hypothyroidism

• there are several rating scales for depression — many are too long

Consequences or Complications of Untreated Depression

• suicide

• alcohol abuse

• other substance abuse

• anxiety (often comorbid with depression)

• heart disease or other medical conditions

• work or school problems

• family conflicts

• relationship difficulties

• social isolation

Depression Causes

• caused by different factors including…

  • genetic predisposition

  • personality

  • stress

  • brain chemistry

Depressive Disorders Specific to Women

• Premenstrual Dysphoric Disorder (PMDD)

• Perinatal Depression

• Postpartum Blues

• Postpartum Depression

Premenstrual Dysphoric Disorder (PMDD)

• severe, sometimes disabling extension of premenstrual symptoms (PMS)

• affects 3-5% of women (PMS affects about 80%)

• causes extreme mood shifts that can disrupt work and relationships

• starts 7-10 days before period starts and continues for the first few days of the period

PMDD — Cause

• unclear

  • not an imbalance of hormones — its the brain exaggerated response to change in hormones

PMDD — Treatment

• try to prevent it if possible

• can be treated

  • antidepressants

  • birth control pills

  • herbal remedies

  • diet

  • induced menopause

PMDD — Symptoms

• sadness

• hopelessness

• extreme moodiness

Perinatal Depression

• refers to depression during pregnancy and in the first year following childbirth

• poses particular risks to the woman, her fetus/child and the rest of the family

• rates of depression in the first trimester are similar to those of age-matched non-pregnant women (7%)

Postpartum Blues

• not a mental health condition

• 50-80% of new mothers experience this transient period of mild depression, mood instability, and anxiety following birth that can last from a few hours up to 10 days postpartum

• no treatment is required other than reassurance (social support)

Postpartum Depression (PPD)

• 10-15% of women meet the diagnostic criteria for clinical depression or MD — men can also get it (2-4%)

  • occurs anytime within 12 months after childbirth (can last 2-6 months)

  • anxiety and depression are due to hormonal changes and concerns about parenting skills

• in 0.1-0.2% of cases, usually within 2 weeks after childbirth, women sugger from severe depression with suicidal ideation

  • in extreme cases, psychotic thinking with hallucinations, delusions, and thoughts of infanticide are possible

    • this is called puerperal psychosis — hospitalization is required

Risk Factors for Postpartum Depression — Strong Predictors

• depression or anxiety during pregnancy

• stressful recent life events (losing your partner during pregnancy or right after)

• poor social support

• previous history of depression

Risk Factors for Postpartum Depression — Moderate Predictors

• childcare stress

• low self-esteem

• maternal neurotism (tendency to experience more negative affect)

• difficult infant temperament

Risk Factors for Postpartum Depression — Small Predictors

• pregnancy and birth complications

• negative cognitive attributions

• single marital status

• poor relationship with partner

• lower SES

Risk Factors for Postpartum Depression — Unrelated Predictors

• maternal age

• ethnicity

• education level

• parity (number of children)

• sex of child

Infant

• term comes from Latin (“in-fans”) and means “unable to speak”

• a newborn infant is called a “neonate” after the final stage of gestation

Gestational Age

• the number of weeks of pregnancy

Large for Gestational Age

• weight is above the 90th percentile at gestational age

  • larger than 90% of babies that age

• 4+ kgs

Appropriate for Gestational Age

• normal birth weight

• 2-4 kgs

Small for Gestational Age

• weight below the 10th percentile at gestational age

  • 90% of infants are larger than them

• less than 2 kgs

Low Birth Weight

• an indicator of the general health of newborns and a key determinant of infant survival, health, and development

• low birth weight infants are at a greater risk of dying in the first year of life, and of developing chronic health problems

• however, with good healthcare and good parenting low birth weight children catch up with other children