Catch Postpartum Depression Before it Starts with Screening

  • Screening for postpartum depression is easy to accomplish by administering self-report screening tests to women during pregnancy or postpartum. The Edinburgh Postnatal Depression Scale (EPDS is one example of an often used screening tool.


    The Edinburgh Postnatal Depression Scale (EPDS) is a well-validated and widely used 10-item self-report screening scale for PPD that was developed to assess the distinguishing mood symptoms present in the postpartum period including severe anxiety and fear, feeling overwhelmed and suicidal thoughts (to self or baby) (Bernstein et al 2008, Cox et al. 1987). The test can usually be completed in less than 5 minutes and is easily administered in an outpatient office setting. The EPDS relies much less than standard depression screens on somatic or physical questions that are difficult to assess in the acute perinatal period. Additionally, the EPDS includes questions about symptoms classically seen in major depressive disorder (MDD) such as sadness, loss of interest or pleasure in activities, feelings of guilt or worthlessness, and sleep difficulties (even when the baby is sleeping) (Cox et al, 1987). A positive score on the EPDS is defined as a total score > 12, based on the standard cut-off reported in the literature (Murphy Eberenz et al, 2006).

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    Barriers to Screening:
    Unfortunately, routine screening for Perinatal Depression is not currently recommended by the American College of Obstetrics and Gynecology; in large part because there are inadequate Perinatal Psychiatry referral resources available for clinicians to refer patients who have positive screens. The sole exception is the State of New Jersey, which developed a bill that was signed into law by then New Jersey Governor Jon Corzine, mandating Universal Screening for PPD in late 2006. The bill requires all obstetrical providers to implement the following: 1) ask all pregnant women about their history of depression or postpartum depression before they give birth, 2) screen all women who have recently given birth and 3) provide psychoeducation to the women and their families about PPD. The State of New Jersey also developed a hotline that new mothers can call for help.


    Finding appropriate resources for the treatment of depression during pregnancy and postpartum can be a challenge for the woman and her family during a very stressful and vulnerable period of time. One very helpful on-line resource is Postpartum Support International (PSI) (www.postpartum.net). The purpose of PSI is to increase awareness among public and professional communities about the emotional changes that women experience during pregnancy and postpartum. PSI has a volunteer coordinator in every one of the United States and in 26 countries in order to disseminate information. The website is easy to navigate so that appropriate local resources can be accessed.

     

    If you feel that you are suffering from perinatal mood symptoms, immediately contact your obstetrical provider and ask to be screened for postpartum depression or referred to an appropriate mental health provider as soon as possible.

     

Published On: October 03, 2008