The DSM-5 identifies nine symptoms of major depressive disorder, shown in the following table. A diagnosis of PPD requires that at least five of the nine diagnostic criteria be present for two weeks or longer. Symptom 1 or symptom 2 must be present for a PPD diagnosis. In addition, symptoms other than symptom 9 must be present and prominent on most days.
Who is at risk?
The greatest risk factor for PPD is a personal history of depression. Women with a history of anxiety or mood symptoms during pregnancy also have an increased risk.
Other recognized risk factors include:
- Personal or family history of mental illness.
- Stressful life situations.
- Isolation and lack of social support.
- Caring for an infant with medical issues or a difficult temperament.
- Hormonal changes following pregnancy.
Women with no known risk factors can also develop PPD.
Postpartum psychosis, the most severe form of PPD, is uncommon. However, in about half of cases, postpartum onset represents the first episode of psychosis. Any woman with psychotic symptoms at the time of evaluation or in the recent past should be referred for emergent psychiatric evaluation.