Criteria<unk>  in the DSM-5 is known as "depressive disorder with peripartum onset". Peripartum onset is defined as starting anytime during pregnancy or within the four weeks following delivery. There is no longer a distinction made between depressive episodes that occur during pregnancy or those that occur after delivery. Nevertheless, the majority of experts continue to diagnose<unk>  as depression with onset anytime within the first year after delivery. The criteria required for the diagnosis of<unk>  are the same as those required to make a diagnosis of non-childbirth related major depression or minor depression. The criteria include at least five of the following nine symptoms, within a two-week period: * Feelings of sadness, emptiness, or hopelessness, nearly every day, for most of the day or the observation of a depressed mood made by others * Loss of interest or pleasure in activities * Weight loss or decreased appetite * Changes in sleep patterns * Feelings of restlessness * Loss of energy * Feelings of worthlessness or guilt * Loss of concentration or increased indecisiveness * Recurrent thoughts of death, with or without plans of suicide Differential diagnosis<unk>  blues<unk>  blues, commonly known as "baby blues," is a transient<unk>  mood disorder characterized by milder depressive symptoms than<unk> . This type of depression can occur in up to 80% of all mothers following delivery. Symptoms typically resolve within two weeks. Symptoms lasting longer than two weeks are a sign of a more serious type of depression. Women who experience "baby blues" may have a higher risk of experiencing a more serious episode of depression later on. Psychosis<unk>  psychosis is not a formal diagnosis, but is widely used to describe a psychiatric emergency that appears to occur in about 1 in a 1000 pregnancies, in which symptoms of high mood and racing thoughts (mania), depression, severe confusion, loss of inhibition, paranoia, hallucinations and delusions begin suddenly in the first two weeks after delivery; the symptoms vary and can change quickly. It is different from<unk>  and from maternity blues. It may be a form of bipolar disorder. It is important not to confuse psychosis with other symptoms that may occur after delivery, such as delirium. Delirium typically includes a loss of awareness or inability to pay attention. About half of women who experience<unk>  psychosis have no risk factors; but a prior history of mental illness, especially bipolar disorder, a history of prior episodes of<unk>  psychosis, or a family history put some at a higher risk.<unk>  psychosis often requires hospitalization, where treatment is antipsychotic medications, mood stabilizers, and in cases of strong risk for suicide, electroconvulsive therapy. The most severe symptoms last from 2 to 12 weeks, and recovery takes 6 months to a year. Women who have been hospitalized for a psychiatric condition immediately after delivery are at a much higher risk of suicide during the first year after delivery. Birth-Related/Postpartum Posttraumatic Stress Disorder Although birth-related posttraumatic stress disorder is not recognized in the DSM-5, there is extensive research being conducted to bring awareness to the posttraumatic stress disorder symptoms one could experience following childbirth. Some research examines the differences and comorbidity when looking into birth-related posttraumatic stress disorder, or<unk>  posttraumatic stress disorder, and<unk> . In the recent research, similarities and differences in symptoms have been identified when it comes to<unk>  posttraumatic stress disorder and<unk> . Although both diagnoses have overlap in their diagnostic criteria, some of the criteria specific to<unk>  include intense hopelessness and sadness, excessive worry or anxiety, intrusive thoughts of harm to oneself or harm to the baby, feelings of guilt or thoughts of worthlessness, and a change in appetite which could result in under-eating or overeating. On the other hand, diagnostic criteria specific to<unk>  posttraumatic stress disorder includes being easily startled, recurring nightmares and flashbacks, avoiding the baby or anything that reminds one of birth, aggression, irritability, and panic attacks. Although these are the symptoms that often help differentiate between<unk>  posttraumatic stress disorder and<unk> , it is important to note that some of these symptoms can cross over to the other diagnosis (e.g., someone meeting the diagnostic criteria of<unk>  may also present with panic attacks, or someone meeting the diagnostic criteria for<unk>  posttraumatic stress disorder may experience depressive episodes, etc.). Another crucial element in diagnosing<unk>  posttraumatic stress disorder following childbirth is when there is a real or perceived trauma before, during, or following childbirth, which is not always required when it comes to diagnosing someone with<unk> . This real or perceived traumatic event that could happen before, during, or following labor and delivery could be toward the baby, mother, or both. These traumatic events could include, but are not limited to unplanned c-section, death, the baby going into the NICU, the use of the vacuum extractor, or forceps during delivery, lack of support and/or reassurance during the delivery (from friends, family, and/or the medical staff), or any other severe physical complication or injury related to childbirth such as preeclampsia, or an unexpected hysterectomy. Conclusions have been made related to the idea of childbirth stressors and the contribution those can play in an increased risk of developing comorbid birth-related posttraumatic stress disorder and<unk>  rather than only a<unk>  diagnosis. Findings like the one mentioned above are crucial in accurate diagnosis to provide the mothers with the most appropriate and effective treatment options, and to advance the validity and reliability of preventative assessments and strategies. Other studies have been able to identify obstetric and perinatal risk factors associated specifically with birth-related posttraumatic stress disorder including educational level, gestational age at delivery, number of prenatal care visits, pregnancy intervals, mode of delivery, any complications with pregnancy, and labor duration. Based on current meta-analytic research, it has been concluded that the prevalence of<unk>  posttraumatic stress disorder was 3.1% in community settings and 15.7% in at-risk populations; however, those findings do state various limitations, including underreporting biases, across the examined studies which lead many researchers to believe the prevalence may be higher. As of right now, there are no widely recognized assessments that measure for<unk>  posttraumatic stress disorder in clinical and medical settings. However, researchers and physicians will often use more reliable posttraumatic stress disorder questionnaires and assessments, which are unfortunately not always specific enough to the posttraumatic symptoms and experiences that are felt before, during, or after childbirth. One assessment for<unk>  posttraumatic stress disorder, the City Birth Trauma Scale (CBTS), has been used in some research settings; however, it is not widely used in clinical and medical settings. The CBTS is a 29-item self-report questionnaire developed to measure birth-related posttraumatic stress disorder, according to the DSM-5 criteria of: symptoms of re-experiencing the event, avoidance, negative cognitions and mood, and hyperarousal, as well as the duration of one’s symptoms and the amount of distress and impairment the symptoms have caused in the individual’s life. The creators of the CTSB also added in two items from the DSM-IV that they felt were relevant to the population being assessed with this measure – that the mothers responded to the traumatic events during childbirth with intense fear, helplessness, or horror and that there were symptoms of emotional numbing. Although the emotional numbing component was excluded in the DSM-5 criteria for posttraumatic stress disorder, research has shown that when studying mothers who have been exposed to trauma, emotional numbing is more predictive of parenting stress than other posttraumatic stress disorder symptoms. Although this assessment shows strong reliability (Cronbach’s alpha = 0.92), and participants from the pilot study found the measure to be easy to understand, this assessment is still not used in clinical or medical settings as often as it is used in research settings. The researchers that have utilized the CTSB have been able to identify various limitations with the pilot study, including the lack of diversity in the sample demographic characteristics (93% White<unk>  women) as well as the self-report nature of the assessment which could lead to underreporting of symptoms. Another assessment that has also been used in research more often than in clinical or medical settings is the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ), which has since been modified into the Perinatal Posttraumatic Stress Disorder Questionnaire-II (PPQ-II), with the modified version being a 14-item scale which does not address all the necessary diagnostic criteria. Further research and development are needed to create a more accurate assessments and screening tools that can differentiate among posttraumatic stress disorders,<unk> /childbirth-related posttraumatic stress disorder, and<unk>  so that the most adequate treatment interventions and options can be implemented as quickly as possible.
Postpartum depression
Postpartum blues
Postpartum disorder
Dysphoric milk ejection reflex
Postpartum psychosis
Premenstrual syndrome
Post-adoption depression syndrome
Premenstrual dysphoric disorder