This analysis examined the secondary effect of a brief alcohol intervention on depressive symptomatology in postpartum women who were drinking above recommended levels within six weeks of delivery. The results showed a significant reduction in depression indicators as measured by the Edinburgh Postnatal Depression Scale. On average, women in the brief alcohol intervention condition reported significantly greater reduction in depressive symptoms at the six-month follow-up than those in the control group.
Depression is a common disorder in the postpartum period, is the most frequent cause of maternal morbidity (O’Hara, 1997
), and is seen as a major predictor of subsequent depression (Campbell & Cohn, 1997
). Women with high levels of depressive symptomatology early in the postpartum period continue to experience significant distress and depressed mood throughout the year following delivery.
Research suggests several factors associated with postpartum depression: perceived lack of social and emotional support (Forman, Videbech, Hedegaard, Salvig & Secher, 2000); a previous psychiatric history; co-morbid alcohol use; tobacco use; binge drinking (Homish et al., 2004
), financial hardship and an unwanted pregnancy (Rich-Edwards et al., 2006
). Unfortunately, many women who experience postpartum depression may not follow-up with routine healthcare appointments, and therefore not be identified as being in need of treatment.
Co-morbid alcohol use and postpartum depression is a complex problem that has received very little attention in the literature. Homish et al. (2004)
analyzed longitudinal data on pregnancy outcome and identified antenatal risk factors associated with these co-occurring conditions. The experience of either increased depressive symptomatology, binge drinking, or smoking at any time during a pregnancy increases a new mother’s risk of co-occurring alcohol abuse and postpartum depression.
Results from the present study looked at the co-occurrence of alcohol use and depressive symptomatology. As screening and brief intervention models become more widely incorporated into the standard of care for women, the resulting improvements will positively affect not only the mother, but the entire family system as well.
The strengths of this study include a sample of women and clinical practices in Wisconsin that includes both rural and urban communities, state of the art research procedures, a large sample, long-term follow-up at 6 months, and high follow-up rates.
This study has several limitations. All reports of alcohol consumption are self-reported. Further, the treatment and control groups did not vary equally with respect to subject loss. Significantly more cases in the treatment group were lost to follow-up. It is possible that those women who completed the study were more motivated and ready to change, thus producing more positive results. And, although the EPDS is a widely-used screening for postpartum depression, it is not a clinical diagnosis of depression. Finally, this study should be replicated with to include a more diverse sample of women of color and a wider range of educational backgrounds to determine what other factors that could be contributing to these results.
The combination of reduced alcohol consumption and reduced depressive symptomatology in new mothers is important due to the broad psychosocial consequences on their children. This novel finding is an initial indicator that brief alcohol interventions can have a more broad impact on postpartum women and other populations than has been considered in previous studies.