Epidemiological Aspects of Parapartum Mental Illness.

Mental illnesses associated with childbearing add unforeseen complexities to prepartum care or postpartum recovery as well as to the responsibilities of marriage and parenthood. While the onset of mental illness at such a time may seem especially tragic, its obstetric background provides ancillary data that may help to identify causative elements. Comparative data are available from the information routinely collected on all maternity cases. Over a century ago, Marce (1858) differentiated the clinical characteristics of prepartum and postpartum mental illnesses. He found no features to distinguish prepartum psychotic and psychoneurotic disturbances from those unassociated with pregnancy. In contrast, he identified syndromes unique to postpartum mental illness. Hamilton (1962) has further delineated the psychiatric syndromes characteristic of postpartum disturbances. The onset is insidious or sudden and the course erratic and unpredictable, as parturition is first followed by a lucid interval and the new mother is later overwhelmed by a confusion or delirium which may or may not be soon dispelled. An epidemiological study (Paffenbarger, 1961) of obstetric and other variables in patients afflicted with psychoses after childbirth has led to further differentiation of prepartum and postpartum mental disturbances. The present paper contrasts mothers whose childbearing experience is accompanied by mental illness and those who escape such troubles. Specific obstetric variables are shown to distinguish prepartum and postpartum mental illness patients fromeach otherandfrom normal childbearing women.