First-Time Mothers, Psychiatric Episodes, Postpartum Psychiatric Disorders

Friday, 26 July 2019

Vanessa Barisano, BSN, RN
School of Nursing, Stony Brook University, Roslyn, NY, USA
Kim Elaine Backman, RN
Dr. Susan Glodstein c/o Stony Brook School of Nursing, Stony Brook University, Stony Brook, NY, USA
Joan Killeen, RN
Stony Brook School of Nursing, Stony Brook University, Stony Brook, NY, USA


Purpose. The purpose of this literature review was to examine whether first-time mothers with no prior history of mental illness or psychiatric hospitalizations, have increased incidence and prevalence of postpartum psychiatric disorders.

Background. Pregnancy is a time in a woman’s life where she faces a future inscribed by significant adjustments. Proper assessment of the mother’s psychological manifestations is an intrinsic part of the postpartum evaluation. However, pregnancy is an opportune time to begin screening for risk factors, maladaptive behaviors, and symptoms of depression or anxiety. Pregnancy is also the time when first-time mothers forge perceptions, attitudes and beliefs about parenthood. These new mothers may struggle with perfectionism and unrealistic expectations of motherhood. Furthermore, postpartum psychiatric disorders or episodes are often under-diagnosed therefore under-treated. Symptoms during pregnancy may often be overlooked as normal changes given that interrupted sleep, fatigue, anxiety and mood lability are associated with pregnancy. Universal maternal screening is not yet the gold standard, although recommended by the United States Preventative Task Force, American Academy of Obstetrics an Gynecology and American Academy of Pediatrics. Reliable and valid screening tools have been found effective in identifying symptoms of anxiety, depression, some with conversion to Bipolar Disorder, and other psychiatric disorders. The utilization of these screening tools can assist with mitigating symptoms thus implementing prevention programs and intervention.

Discussion. A thorough literature search of five databases was conducted to identify studies from 2009 to present time as to not exclude any recent published studies. Database analysis included PubMed, Embase, Cochrane, CINAHL Plus with full text, and PsycINFO. The articles obtained that were in accordance with our inclusion/exclusion were narrowed to a total of nine articles.

Conclusion. In conclusion, this integrative review revealed that first-time mothers have increased risk for developing psychiatric disorders with a postpartum onset especially within the first three months. Most studies evaluated women of European ethnicities thus not globally representative. Given the tremendous growth of immigrant population, further research in the United States among low income, immigrant women are especially critical.