Saturday, October 20, 2012

Postpartum Depression Screening

Postpartum depression has been called "the most common problem associated with childbirth," affecting about 13% of new mothers, or approximately 500,000 women each year (1). Postpartum depression (PPD) can have lasting effects on mothers and babies; untreated (or insufficiently treated), it can lead to bonding difficulties and developmental delays in infants (2). Women who experience PPD report the typical symptoms of situational or chronic depression: sadness; loss of energy; changes in eating habits (significantly decreased or increased apetite); emotional numbness; insomnia; loss of interest in sex; irritability and anger (sometimes intense), as well as mood swings, poor bonding, and strong feelings of shame and guilt associated with cultural disapproval of perceived weakness or selfishness of mothers who feel anything less than total bliss towards their new babies (4).

At least half of these mothers, and potentially many more, are never diagnosed, and may suffer needlessly-- a true tragedy of modern medicine, considering that screening for the disorder is simple, fast, reliable, and inexpensive. There are several tools available to screen new mothers for PPD; the most common is the tried-and-true Edinburgh Postnatal Depresson Scale (5), which was developed in the UK and has been used for over 20 years to reliably predict patients' risk of developing PPD (6,7). The format is simple: a 10-item self-administered questionnaire, which should be answered by the mother herself, that can be completed in about five minutes and reviewed immediately with care providers. The tool is available at no cost to the administering institution, and can be duplicated with attribution; it is easy to score and results are instantaneous. Each item is scored with 0, 1, 2, or 3 points, and the resulting score is compared to a standardized scale-- the higher the score (30 is the maximum), the more likely the woman is to develop PPD. A score of 12 or higher is considered to be predictive of PPD, while a score of 21-30 is considered high risk and may necessitate immediate consult with the woman's physician (8).

The EPDS has been validated as effective by many quantitative studies, although sound clinical judgment should always be used in interpreting results (10). Each individual found to be at risk should be evaluated by a medical professional not only shortly after birth, but at the initial postpartum checkup (4-6 weeks), and, ideally, at 3 and 6 months postpartum (11). Some researchers have suggested that screening should be done not only in obstretric offices, but in pediatric clinics as well, to facilitate the identification of as many cases as possible (12). Further, since most mothers who experience PPD also experienced at least one depressive episode prenatally, it has been recommended by some that obstetricians should screen their pregnancy patients at least once per trimester during routine prenatal care (13). While ACOG (the American College of Obstetricans and Gynecologists) cites inadequate evidence to recommend a standard of care, they do recognize the need for screenings, as well as treatment, follow up, and referral as required (14).

References Cited

1.,  retrieved 10/20/2012

2. Is your new mom depressed? (Did you ask?) Schaar GL - Journal for Nurse Practitioners -  November/December 2011; 7(10); 879-880

3.,  retrieved 10/20/2012

4.,  retrieved 10/20/2012

5.,  retrieved 10/20/2012

6. Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item

Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786.

7. Applying new techniques to an old ally: A qualitative validation study of the Edinburgh Postnatal Depression Scale

Godderis R - Women Birth - March, 2009; 22(1); 17-23

8. Schaar 2011

9. Godderis 2009

10. Mothers With Positive or Negative Depression Screens Evaluate a Maternal Resource Guide

Pascoe JM - Journal of Pediatric Health Care - November/December 2010; 24(6); 378-384

11.Screening for postpartum depression. Cole C - Journal for Nurse Practitioners - 01 January 2009; 5(6): 460-461

12. Pascoe 2010

13. Screening for perinatal depression with limited psychiatric resources. Jevitt, C., Zapata, L., Harrington, M., and Berry, E. Journal of the American Psychiatric Nurses Association, Vol. 11, No. 6

14. Screening for Depression During and After Pregnancy. Committee on Obstretic Practice, American College of Obstetricians and Gynecologists, February 2010. Retrieved from,  10/20/2012

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