It has been well established that the year after giving birth is a period of heightened vulnerability to psychiatric illness in women, in particular mood disorders. There has been substan- tial recent research into the incidence, risk factors and short- and longer-term adverse sequelae of postpartum psychiatric illness, in particular depression. 1 Most research has focused on identifying women with diagnosable psychiatric illness and establishing appropriate treatment interventions. It is implicit in this theoretical approach that those who do not satisfy the criteria for being psychiatric cases are symptom-free. An alternative view is that postpartum psychological distress is universal and an unavoidable correlate of a major life transi- tion. 2 In this conceptualization, the severity of distress is distributed along a continuum; a small proportion experience psychiatric illness, some experience moderate or mild psycho- logical symptoms and others experience relatively little distress. There has been less research into the relevance of fatigue and anxiety to postpartum psychological disturbance. Elevated anxiety in parturient women has been associated with increased difficulties in adapting to the work of motherhood, but there is debate about whether this is attributable primarily to a fixed personal style, or is instead a response to traumatic events beyond the individual’s control. 3–5 There is also recent evidence to suggest that chronic maternal sleep deprivation may be misdiagnosed as postnatal depression. 6,7 It has been shown that a condition of ‘vital exhaustion’, characterized by excess fatigue and diminished functional capacity, is distinct from depression in other settings, but this notion has not yet been explored in relation to postnatal mood disturbance. 8 A range of studies has characterized the nature of presenting problems of women and infants admitted to specialized psychi- atric and public access residential parentcraft units. 9–13 The aim of the present study was to establish the nature, severity and correlates of psychological distress in women admitted with their infants to the Masada Private Hospital Mother–Baby Unit (MPHMBU). METHODS An opportunity to complete a detailed self-report questionnaire was offered to all women admitted with their infants to the MPHMBU between 1 June and 30 November 1997. The ques- tionnaire incorporated standardized valid, reliable, published J. Paediatr. Child Health (2002) 38, 140–145 Nature, severity and correlates of psychological distress in women admitted to a private mother–baby unit JRW FISHER, 1 CJ FEEKERY 2 and HJ ROWE-MURRAY 1 1 Key Centre for Women’s Health in Society, University of Melbourne, Carlton and 2 Royal Children’s Hospital, Melbourne, Victoria, Australia Objective: To characterize psychological distress of women admitted with their infants to a private hospital mother–baby unit. Methods: A cross-sectional self-report survey including standardized psychometric questionnaires of consecutive admis- sions to Masada Private Hospital Mother–Baby Unit, Melbourne between 1 June and 30 November 1997. Scores on the Profile of Mood States, Edinburgh Postnatal Depression Scale, Intimate Bonds Measure, Parental Bonding Instrument, Social Support Questionnaire, Vulnerable Personality Scale self-report instruments and responses to a structured self-report questionnaire. Of the women admitted, 109 out of 146 participated in the survey. Results: Clinically significant fatigue was almost universal in this cohort. Psychological distress clustered into three distinct groups: (i) probable depression; (ii) fatigue and distress; and (iii) fatigue only. It may be more accurate to conceptu- alise postpartum psychological distress either as a continuum, or as a wide range of distinct states, rather than as a dichoto- mous condition in which individuals are categorized as being or not being cases. In this cohort, the severity of distress was associated most consistently with the quality of a woman’s relationship with her partner and with infants who were difficult to settle. Conclusions: It appears that some cases of psychological distress in women following childbirth may be inaccurately conceptualised as depression. Clinically significant fatigue and moderate distress are distinguishable from depression, and warrant specifically tailored assessment strategies and treatments. Following the birth of a baby, the partner of a mother has a strong influence on her emotional health and should be included in any assessment and intervention. Key words: maternal health; mental health; postpartum depression; postpartum women. Correspondence: Dr Jane Fisher, Key Centre for Women’s Health in Society, University of Melbourne, Carlton, Victoria 3010, Australia. Fax: +61 3 9347 9824; email: jrwf@unimelb.edu.au Accepted for publication 23 April 2001.