Tom Cruise might not believe that postpartum depression exists, but there is a very real risk that first-time moms will develop serious mental illness -- such as schizophrenia, depression and bipolar disorder -- during the first three months after childbirth.
This study, published in today's issue of the Journal of the American Medical Association, is the largest ever to look at postpartum depression and the first to look at other kinds of serious postpartum mental illness, such as schizophrenia.
Danish researchers studied health and civic records collected over 32 years from 1 million first-time parents -- from the time their child was born until the child's first birthday. During those years, a total of 1,171 women and 658 men were admitted, with a mental disorder, to a psychiatric hospital during their first year of parenthood, says the study. So, new moms might be at risk for serious mental illness, but new dads aren't as vulnerable, researchers said.
First-time mothers were seven times more likely to be hospitalized for a severe mental illness than second-time moms who had given birth 11 to 12 months before, researchers say. These first-timers were so sick that they had to be hospitalized to treat their mental illness, and not just treated as outpatients. The greatest risk for mental illness was 10 to 19 days after childbirth, but the risk was still significant three months later.
Within that same early time period, women were nearly three times as likely to visit an outpatient facility for mental illness treatment compared with moms who had given birth a year ago.
Postpartum depression is a relatively common problem, estimated to affect one in seven new mothers, but researchers estimate postpartum depression isn't ever diagnosed in roughly 40 to 50 percent of cases, so the problem could be even more common.
Postpartum mental illness -- which affects one in 1,000 births -- can also be something more severe. Newspaper reports suggest postpartum psychosis likely played a role in the case of Andrea Yates, the mother who drowned her five children in a bathtub in Texas. Though Yates had not given birth shortly before she drowned her children, this story shows that mental illness can be devastating for a new mother, her newborn child and her family.
Since new mothers are especially vulnerable to mental illness inside of the first month of motherhood, doctors worry that new moms miss their best chance to be diagnosed and treated early because new moms are often at home and isolated from their doctors.
Usually, patients "come back [to the obstetrician] between two and six weeks, and that can be a little bit late," said Dr. Celia Dominguez, assistant professor of gynecology and obstetrics in the division of reproductive endocrinology and infertility at Emory University in Atlanta.
By the time the typical new mother sees her doctor again, she may have already fallen too far into a serious mental illness. "[By that time] we have totally missed the boat, " said Dominguez.
First-time dads, on the other hand, had no increased risk of being hospitalized with a psychiatric illness and were no more likely to need outpatient psychiatric therapy compared with men who had fathered children the year before.
This is the first large-scale study that shows a link between childbirth and mental illness. "[The researchers] focus on severe psychiatric illness which really hasn't been done before, [and] is really important," said Dominguez.
Doctors -- and not just doctors who deliver babies -- feel this is a landmark study because it brings attention to an important public health need that is rarely mentioned. "The significance for this study in the medical community is that recognition is key to addressing this public health problem," said Dr. Dorothy Sit, assistant professor of psychiatry at the University of Pittsburgh School of Medicine.
"Often [postpartum mental illness] is not discussed," said Dominguez, because of the stigma surrounding mental illness. "Sometimes women are told to grin and bear it.
"I think there is a concept of superwomen, and some of the patients don't believe [mental illness] could happen to them."
Doctors hope this report will help new moms -- who do suffer symptoms of mental illness -- to speak up and get help.
"I think there is always need for getting the public to realize that psychiatric illness can happen to anyone, even when they're 'doing everything right' and even when potentially joyful events are happening," said Dr. Christine Barney, a private practice psychiatrist in White River Junction, Vt.
This public awareness could ultimately be better for baby. If mommy's mental illness is diagnosed early, it could protect baby from potential harm.
"[Mental illness in mom] can negatively impact a newborn's mental and motor development, and is associated with low self-esteem and behavior problems," said Sit.
The study illustratrates the reality that the sexes are not equally vulnerable when it comes to mental illness. Mental illness seems to hit first-time moms harder than it hits first-time dads, but experts can't say why that is.
It could be because of a woman's hormones, experts suggest, or it could have more to do with the pressure of being a parent.
"It may not only be hormones but also expectations of being a new mom" that make women more susceptible to mental illness, said Dominguez.
Perhaps the pressure of new motherhood brings out a mental illness that otherwise would have lay dormant, experts said.
"These women could have an underlying but unrecognized disorder that becomes apparent in the postpartum," said Sit.
These underlying psychiatric illnesses may be "more likely to become manifest when a woman is stressed, scared, socially isolated, fatigued and sleep-deprived," as with a new baby, said Barney.
The findings suggest that mothers are more involved in raising children than men, and that this change in lifestyle is what causes more mental illness in women than men after childbirth, according to study author Trine Munk-Olsen at the National Center for Register-Based Research in Aarhus, Denmark.
Munk-Olsen and her colleagues also said that men may be more vulnerable to mental illness than the data lets on, because men may seek medical help for psychiatric illness less often than women do.
It's hoped that this study will not only educate physicians to look for earlier warning signs of depression but will also educate new moms and dads to look for the signs of depression.
These symptoms may include depressed mood, poor concentration, loss of energy, lack of enjoyment of activities, and impaired sleep, even when the baby is sleeping. Symptoms suggesting psychosis include hearing voices or increased suspiciousness.
Families should "be vigilant for these symptoms, especially in the first three months postpartum and if the woman is a first-time mom," said Sit.
The study will also help lessen the stigma of mental illness. "We need to start taking mental health more seriously," said Dominguez. "Mental health is health, and in the past, we've pooh-poohed mental health; it is critical to the functionality of the person."
So, if Brooke Shields and Tom Cruise start fighting again over the existence of postpartum mental illness, Brooke has some new ammunition.