Interview with Poul Videbech, professor, dr. med.
Post-partum depression is a common disorder that may take several forms and that very frequently may be prevented or minimized with early intervention.
Some years ago, you were a co-author of a book on post-partum depression (Fødselsdepression) having as target groups women with depression and their relatives as well as health personal. What was the incentive to write this book?
A Swedish study had demonstrated that the condition was often not recognized and that around one third of the cases did not get any help. Furthermore, the condition is more common than what is generally known. There are still taboos related to post-partum depression that it is important to break and inform about the importance of early detection in order to avoid that the depression may become more chronic and have a negative impact on the woman concerned as well as the entire family.
How frequent is post-partum depression?
Results from a Danish study shows that approximately 6% of women giving birth in Denmark may develop a depressive disorder post-partum. In a certain proportion the depression may start during pregnancy. Here a study from the US shows that up to 10% of women develop a depressive disorder some time during their pregnancy, the size depending upon what kind of rating scale used. But it is important to keep in mind that the risk of developing depression is associated with the standard of peri-natal care offered to the pregnant women. The better, more comprehensive the care the less is the likelihood to develop a depression. And in the Nordic region we are lucky that high standard programs in general are offered to pregnant women.
But despite adequate care some women may develop a depression while pregnant. For some the depression subsides before childbirth for others it continues and becomes a post-partum depression.
We should not confound the post-partum depression with the short-lasting condition Maternity blues that is extremely common in the days following childbirth.
Two types of depression may develop: 1. Sudden depressive episode, frequently a manifestation of a recurrent depression and 2. A depressive condition as part of a bipolar disorder.
Being a professor in adult psychiatry is it your impression that the area “peri-natal mental health” is receiving sufficient attention in the curriculum of doctors and other health professions?
It is my impression that the field is receiving increasing attention from many sides in recognition of how important it is to focus on mental health aspects of the peri-natal period.
In the ante-natal clinics we find midwifes with training and interest in spotting pregnant women in risk of developing a depressive episode in order to start early intervention before the condition worsens.
After childbirth the health visitors also carry out an important task in identifying those women who show signs of depression, and there is an increasing focus in their work on its mental health aspects.
In the medical profession the training of obstetricians may not be adequate when it comes to mental health aspects. To overcome this shortage, I have written a chapter on the subject in a textbook of obstetrics used in Denmark.
Coming to the therapeutic aspects we see in some countries Mother - baby units”. Do you recommend such an approach?
I find mother- baby units a fine approach and it has partly existed in Denmark. The problem today is that we do not have sufficient resources in our mental health services to allow babies to stay together with their mothers in a psychiatric ward and gradually as the maternal condition improves giving her more time to take care of the baby. Instead, today the baby will be taken care of by relatives or in some cases admitted to a pediatric ward. And with respect to the mother-baby units I am sorry to say that I doubt that the necessary resources will be available in the future.
How do we prevent that women develop depressive episodes during pregnancy and after childbirth?
I think that it is important to emphasize that many therapeutic interventions have a prophylactic nature in the form of early identification – in the ante-natal clinic as with health visitors. A Scottish study has shown that providing a limited amount of extra hours for the health visitor – and we talk about no more than approx. 5 hours– had a marked positive effect on the emerging depressive condition.
We have in Denmark a well-developed tradition of groups of mothers (mødregrupper) that are fine for women without psychiatric conditions but are not suited to identify or support women with more serious mental problems. Here a trained health visitor may be crucial in identifying and supporting the mother and if required overlook that she is referred to more specialized treatment combined with municipal pedagogical support.
So, in the light of the available resources what do you see as adequate therapeutic intervention?
An intensive collaboration between psychiatry and obstetrics is very useful and this collaboration exists. Today in several places in Denmark however primarily in university settings.
A certain percentage of women will need psychopharmacological treatment. This I see as a task for specialists not least monitoring psychopharmacological intervention during pregnancy. Modern technology the establishment of hotlines, video-consultations, etc. facilitates the availability of this. □