Skip to main content

Advertisement

Log in

A depressive symptoms responsiveness model for differentiating fatigue from depression in the postpartum period

  • Original contribution
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Summary

Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is experienced by most non-depressed women. Health care providers experientially know that not all women who experience postpartum fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they have not yet identified a means for describing or measuring this distinctness. A new model proposing how fatigue may be differentiated from depression after childbirth is presented. The Depressive Symptoms Responsiveness Model proposes that depression-related postpartum fatigue may potentially be differentiated from non-depression-related postpartum fatigue on the basis of whether depressive symptoms abate when fatigue is relieved. The ability to differentiate between fatigue and depression in postpartum women has the potential to improve women’s health through improvements in practice and resource utilization. Furthermore, differentiation may lead to a better understanding of the role of fatigue in postpartum depression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • LS Aaronson CS Teel V Cassmeyer GB Neuberger L Pallikkathayil J Pierce et al. (1999) ArticleTitleDefining and measuring fatigue Image J Nurs Scholarsh 31 45–50 Occurrence Handle10.1111/j.1547-5069.1999.tb00420.x Occurrence Handle1:STN:280:DyaK1M7otFSmsQ%3D%3D

    Article  CAS  Google Scholar 

  • InstitutionalAuthorNameAmerican Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV American Psychiatric Association Washington, DC

    Google Scholar 

  • L Baker S Cross L Greaver G Wei R Lewis (2005) ArticleTitlePrevalence of postpartum depression in a Native American population Matern Child Health J 9 21–25 Occurrence Handle15880971 Occurrence Handle10.1007/s10995-005-2448-2

    Article  PubMed  Google Scholar 

  • DS Baldwin GI Papakostas (2006) ArticleTitleSymptoms of fatigue and sleepiness in major depressive disorder J Clin Psychiatry 67 IssueIDSuppl 6 9–15 Occurrence Handle16848671

    PubMed  Google Scholar 

  • B Barnet A Joffe AK Duggan MD Wilson JT Repke (1996) ArticleTitleDepressive symptoms, stress, and social support in pregnant and postpartum adolescents Arch Pediatr Adolesc Med 150 64–69 Occurrence Handle8542009 Occurrence Handle1:STN:280:DyaK287jtlansw%3D%3D

    PubMed  CAS  Google Scholar 

  • CT Beck (1992) ArticleTitleThe lived experience of postpartum depression: a phenomenological study Nurs Res 41 166–170 Occurrence Handle1584660 Occurrence Handle10.1097/00006199-199205000-00008 Occurrence Handle1:STN:280:DyaK383mt1ansA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • CT Beck (1993) ArticleTitleTeetering on the edge: a substantive theory of postpartum depression Nurs Res 42 42–48 Occurrence Handle8424067 Occurrence Handle10.1097/00006199-199301000-00008 Occurrence Handle1:STN:280:DyaK3s7ktFChsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • CT Beck (2004) ArticleTitlePost-traumatic stress disorder due to childbirth: the aftermath Nurs Res 53 216–224 Occurrence Handle15266160 Occurrence Handle10.1097/00006199-200407000-00004

    Article  PubMed  Google Scholar 

  • CT Beck RK Gable (2000) ArticleTitlePostpartum Depression Screening Scale: development and psychometric testing Nurs Res 49 272–282 Occurrence Handle11009122 Occurrence Handle10.1097/00006199-200009000-00006 Occurrence Handle1:STN:280:DC%2BD3cvlt1Onsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • CT Beck P Indman (2005) ArticleTitleThe many faces of postpartum depression J Obstet Gynecol Neonatal Nurs 34 569–576 Occurrence Handle16227512 Occurrence Handle10.1177/0884217505279995

    Article  PubMed  Google Scholar 

  • AB Berenson CR Breitkopf ZH Wu (2003) ArticleTitleReproductive correlates of depressive symptoms among low-income minority women Obstet Gynecol 102 1310–1317 Occurrence Handle14662220 Occurrence Handle10.1016/j.obstetgynecol.2003.08.012

    Article  PubMed  Google Scholar 

  • I Bozoky EJ Corwin (2002) ArticleTitleFatigue as a predictor of postpartum depression J Obstet Gynecol Neonatal Nurs 31 436–443 Occurrence Handle12146933 Occurrence Handle10.1111/j.1552-6909.2002.tb00066.x

    Article  PubMed  Google Scholar 

  • S Callahan N Séjourné A Denis (2006) ArticleTitleFatigue and breastfeeding: an inevitable partnership? J Hum Lact 22 182–187 Occurrence Handle16684906 Occurrence Handle10.1177/0890334406286972

    Article  PubMed  Google Scholar 

  • NJ Caltabiano ML Caltabiano (1996) ArticleTitleRelationship between exhaustion and postnatal depression Psychol Rep 79 225–226 Occurrence Handle8873809 Occurrence Handle1:STN:280:DyaK2s%2FislOjug%3D%3D

    PubMed  CAS  Google Scholar 

  • EJ Corwin J Brownstead N Barton S Heckard K Morin (2005) ArticleTitleThe impact of fatigue on the development of postpartum depression J Obstet Gynecol Neonatal Nurs 34 577–586 Occurrence Handle16227513 Occurrence Handle10.1177/0884217505279997

    Article  PubMed  Google Scholar 

  • JL Cox JM Holden R Sagovsky (1987) ArticleTitleDetection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale Br J Psychiatry 150 782–786 Occurrence Handle3651732 Occurrence Handle1:STN:280:DyaL1c%2FgtFahtw%3D%3D Occurrence Handle10.1192/bjp.150.6.782

    Article  PubMed  CAS  Google Scholar 

  • JL Cox D Murray G Chapman (1993) ArticleTitleA controlled study of the onset, duration and prevalence of postnatal depression Br J Psychiatry 163 27–31 Occurrence Handle8353695 Occurrence Handle1:STN:280:DyaK3szlvVWmug%3D%3D

    PubMed  CAS  Google Scholar 

  • K Dalton WM Holton (2001) Depression after childbirth EditionNumber4 Oxford University Press New York

    Google Scholar 

  • CL Dennis L Ross (2005) ArticleTitleRelationships among infant sleep patterns, maternal fatigue, and development of depressive symptomatology Birth 32 187–193 Occurrence Handle16128972 Occurrence Handle10.1111/j.0730-7659.2005.00368.x

    Article  PubMed  Google Scholar 

  • MB First A Frances HA Pincus (2002) DSM-IV-TR handbook of differential diagnosis American Psychiatric Press Washington, DC

    Google Scholar 

  • GF Foss (2001) ArticleTitleMaternal sensitivity, posttraumatic stress, and acculturation in Vietnamese and Hmong mothers MCN Am J Matern Child Nurs 26 257–263 Occurrence Handle11552576 Occurrence Handle10.1097/00005721-200109000-00009 Occurrence Handle1:STN:280:DC%2BD3Mrgt1GltA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • DL Gardner (1991) ArticleTitleFatigue in postpartum women Appl Nurs Res 4 57–62 Occurrence Handle1741638 Occurrence Handle1:STN:280:DyaK38%2FnsVygtg%3D%3D Occurrence Handle10.1016/S0897-1897(05)80056-4

    Article  PubMed  CAS  Google Scholar 

  • CL Gay KA Lee S Lee (2004) ArticleTitleSleep patterns and fatigue in new mothers and fathers Biol Res Nurs 5 311–318 Occurrence Handle15068660 Occurrence Handle10.1177/1099800403262142

    Article  PubMed  Google Scholar 

  • Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, et al. (2005) Perinatal depression: Summary, Evidence Report/Technology Assessment: Number 119. AHRQ Publication Number 05-E006-1. Agency for Healthcare Research and Quality, Rockville, MD

  • BG Glaser (1992) Basics of grounded theory analysis Sociology Press Mill Valley, CA

    Google Scholar 

  • BG Glaser AL Strauss (1967) The discovery of grounded theory Aldine Chicago

    Google Scholar 

  • D Goyal SO Murphy J Cohen (2006) ArticleTitleImmigrant Asian Indian women and postpartum depression J Obstet Gynecol Neonatal Nurs 35 98–104 Occurrence Handle16466357 Occurrence Handle10.1111/j.1552-6909.2006.00007.x

    Article  PubMed  Google Scholar 

  • SE Hobfoll C Ritter J Lavin MR Hulsizer RP Cameron (1995) ArticleTitleDepression prevalence and incidence among inner-city pregnant and postpartum women J Consult Clin Psychol 63 445–453 Occurrence Handle7608357 Occurrence Handle10.1037/0022-006X.63.3.445 Occurrence Handle1:STN:280:DyaK2Mzjt1GitA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • EA Howell PA Mora CR Horowitz H Leventhal (2005) ArticleTitleRacial and ethnic differences in factors associated with early postpartum depressive symptoms Obstet Gynecol 105 1442–1450 Occurrence Handle15932842

    PubMed  Google Scholar 

  • K Kendall-Tackett (2007a) ArticleTitleA new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health Int Breastfeed J 2 6–6 Occurrence Handle10.1186/1746-4358-2-6

    Article  Google Scholar 

  • KA Kendall-Tackett (2007b) ArticleTitleViolence against women and the perinatal period: the impact of lifetime violence and abuse on pregnancy, postpartum, and breastfeeding Trauma Violence Abuse 8 344–353 Occurrence Handle10.1177/1524838007304406

    Article  Google Scholar 

  • RC Kessler (2002) ArticleTitleEpidemiology of women and depression J Affect Disord 74 5–13 Occurrence Handle10.1016/S0165-0327(02)00426-3

    Article  Google Scholar 

  • M Lavidor A Weller H Babkoff (2003) ArticleTitleHow sleep is related to fatigue Br J Health Psychol 8 95 Occurrence Handle12643819 Occurrence Handle10.1348/135910703762879237

    Article  PubMed  Google Scholar 

  • KA Lee (1998) ArticleTitleAlterations in sleep during pregnancy and postpartum: a review of 30 years of research Sleep Med Rev 2 231–242 Occurrence Handle15310494 Occurrence Handle10.1016/S1087-0792(98)90010-7 Occurrence Handle1:STN:280:DC%2BD2cvgs1ymtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • KA Lee (2003) Impaired sleep V Carrieri-Kohlman AM Linsey CM West (Eds) Pathophysiological phemonena in nursing: Human responses to illness EditionNumber3 Saunders St. Louis, MO 363–385

    Google Scholar 

  • KA Lee (2006) ArticleTitleSleep dysfunction in women and its management Curr Treat Options Neurol 8 376–386 Occurrence Handle16901377 Occurrence Handle10.1007/s11940-006-0027-5

    Article  PubMed  Google Scholar 

  • KA Lee TM Ward (2005) ArticleTitleCritical components of a sleep assessment for clinical practice settings Issues Ment Health Nurs 26 739–750 Occurrence Handle16126649 Occurrence Handle10.1080/01612840591008320

    Article  PubMed  Google Scholar 

  • KA Lee G Hicks G Nino-Murcia (1991) ArticleTitleValidity and reliability of a scale to assess fatigue Psychiatry Res 36 291–298 Occurrence Handle2062970 Occurrence Handle10.1016/0165-1781(91)90027-M Occurrence Handle1:STN:280:DyaK3M3ovVOjtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • ER Lenz LC Pugh (2003) The theory of unpleasant symptoms MJ Smith PR Liehr (Eds) Middle range theory for nursing Springer Publishing New York 69–90

    Google Scholar 

  • J Madden S Newton (2006) ArticleTitleWhy am I so tired all the time? Understanding cancer-related fatigue Clin J Oncol Nurs 10 659–661 Occurrence Handle17063618 Occurrence Handle10.1188/06.CJON.615-619

    Article  PubMed  Google Scholar 

  • CA McVeigh (2000) ArticleTitleInvestigating the relationship between satisfaction with social support and functional status after childbirth MCN Am J Matern Child Nurs 25 25–30 Occurrence Handle10676082 Occurrence Handle10.1097/00005721-200001000-00006 Occurrence Handle1:STN:280:DC%2BD3c7ktVCqsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • RT Mercer (1986) First-time motherhood: experiences from teens to forties Springer Publishing New York

    Google Scholar 

  • RA Milligan PM Flenniken LC Pugh (1996) ArticleTitlePositioning intervention to minimize fatigue in breastfeeding women Appl Nurs Res 9 67–70 Occurrence Handle8871433 Occurrence Handle10.1016/S0897-1897(96)80435-6 Occurrence Handle1:STN:280:DyaK2s%2FisFaisg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • RA Milligan ER Lenz PL Parks LC Pugh H Kitzman (1997) Postpartum fatigue: clarifying a concept AG Gift (Eds) Clarifying concepts in nursing research Springer Publishing New York 97–109

    Google Scholar 

  • MM O’Reilly (2004) ArticleTitleAchieving a new balance: women’s transition to second-time parenthood J Obstet Gynecol Neonatal Nurs 33 455–462 Occurrence Handle15346671 Occurrence Handle10.1177/0884217504266911

    Article  PubMed  Google Scholar 

  • PL Parks ER Lenz RA Milligan H Han (1999) ArticleTitleWhat happens when fatigue lingers for 18 months after delivery? J Obstet Gynecol Neonatal Nurs 28 87–93 Occurrence Handle9924869 Occurrence Handle10.1111/j.1552-6909.1999.tb01969.x Occurrence Handle1:STN:280:DyaK1M7it1amtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • LC Pugh RA Milligan (1998) ArticleTitleNursing intervention to increase the duration of breastfeeding Appl Nurs Res 11 190–194 Occurrence Handle9852662 Occurrence Handle10.1016/S0897-1897(98)80318-2 Occurrence Handle1:STN:280:DyaK1M%2FmvFOltg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • LC Pugh RA Milligan PL Parks ER Lenz H Kitzman (1999) ArticleTitleClinical approaches in the assessment of childbearing fatigue J Obstet Gynecol Neonatal Nurs 28 74–80 Occurrence Handle9924867 Occurrence Handle10.1111/j.1552-6909.1999.tb01967.x Occurrence Handle1:STN:280:DyaK1M7it1amtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • K Reuter M Härter (2004) ArticleTitleLiterature review. The concepts of fatigue and depression in cancer Eur J Cancer Care 13 127–134 Occurrence Handle10.1111/j.1365-2354.2003.00464.x Occurrence Handle1:STN:280:DC%2BD2c3hslOgsQ%3D%3D

    Article  CAS  Google Scholar 

  • LE Ross VL Campbell CL Dennis ER Blackmore (2006) ArticleTitleDemographic characteristics of participants in studies of risk factors, prevention, and treatment of postpartum depression Can J Psychiatry 51 704–710 Occurrence Handle17121169

    PubMed  Google Scholar 

  • JJ Runquist (2007) ArticleTitlePersevering through postpartum fatigue J Obstet Gynecol Neonatal Nurs 36 28–37 Occurrence Handle17238944 Occurrence Handle10.1111/j.1552-6909.2006.00116.x

    Article  PubMed  Google Scholar 

  • J Rychnovsky (2007) ArticleTitlePostpartum fatigue in the active-duty military woman J Obstet Gynecol Neonatal Nurs 36 38–46 Occurrence Handle17238945 Occurrence Handle10.1111/j.1552-6909.2006.00112.x

    Article  PubMed  Google Scholar 

  • J Rychnovsky CT Beck (2006) ArticleTitleScreening for postpartum depression in military women with the Postpartum Depression Screening Scale Mil Med 171 1100–1104 Occurrence Handle17153549

    PubMed  Google Scholar 

  • JE Schwartz L Jandorf LB Krupp (1993) ArticleTitleThe measurement of fatigue: a new instrument J Psychosom Res 37 753–762 Occurrence Handle8229906 Occurrence Handle10.1016/0022-3999(93)90104-N Occurrence Handle1:STN:280:DyaK2c%2Fks1OhsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • R Stremler E Hodnett KA Lee S MacMillan C Mill L Ongcangco et al. (2006) ArticleTitleA behavioral-educational intervention to promote maternal and infant sleep: a pilot randomized, controlled trial Sleep 29 1609–1615 Occurrence Handle17252892

    PubMed  Google Scholar 

  • T Tammentie E Paavilainen Pi Astedt-Kurki M-T Tarkka (2004) ArticleTitleFamily dynamics of postnatally depressed mothers – discrepancy between expectations and reality J Clin Nurs 13 65–74 Occurrence Handle14687295 Occurrence Handle10.1046/j.1365-2702.2003.00824.x

    Article  PubMed  Google Scholar 

  • NW Troy (2003) ArticleTitleIs the significance of postpartum fatigue being overlooked in the lives of women? MCN Am J Matern Child Nurs 28 252–257 Occurrence Handle12840692 Occurrence Handle10.1097/00005721-200307000-00009

    Article  PubMed  Google Scholar 

  • NW Troy P Dalgas-Pelish (2003) ArticleTitleThe effectiveness of a self-care intervention for the management of postpartum fatigue Appl Nurs Res 16 38–45 Occurrence Handle12624861 Occurrence Handle10.1053/apnr.2003.50001

    Article  PubMed  Google Scholar 

  • L Tulman J Fawcett (1988) ArticleTitleReturn of functional ability after childbirth Nurs Res 37 77–81 Occurrence Handle3347523 Occurrence Handle1:STN:280:DyaL1c7lslOluw%3D%3D

    PubMed  CAS  Google Scholar 

  • L Tulman J Fawcett L Groblewski L Silverman (1990) ArticleTitleChanges in functional status after childbirth Nurs Res 39 70–75 Occurrence Handle2315069 Occurrence Handle10.1097/00006199-199003000-00002 Occurrence Handle1:STN:280:DyaK3c7pt1ajsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • DN Ugarriza (2002) ArticleTitlePostpartum depressed women’s explanation of depression J Nurs Scholarsh 34 227–233 Occurrence Handle12237984 Occurrence Handle10.1111/j.1547-5069.2002.00227.x

    Article  PubMed  Google Scholar 

  • MK Weinberg EZ Tronick M Beeghly KL Olson H Kernan JM Riley (2001) ArticleTitleSubsyndromal depressive symptoms and major depression in postpartum women Am J Orthopsychiatry 71 87–97 Occurrence Handle11271721 Occurrence Handle10.1037/0002-9432.71.1.87 Occurrence Handle1:STN:280:DC%2BD3M7ntFemsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • InstitutionalAuthorNameWorld Health Organization (1993) The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research WHO Geneva

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. J. Runquist.

Additional information

Correspondence: Jennifer J. Runquist, PhD, RN, Assistant Professor, College of Nursing, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201, U.S.A.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Runquist, J. A depressive symptoms responsiveness model for differentiating fatigue from depression in the postpartum period. Arch Womens Ment Health 10, 267–275 (2007). https://doi.org/10.1007/s00737-007-0208-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-007-0208-6

Navigation