Various screening tools have been used to identify women with postpartum depression (PPD. The most widely used self-report tools for detection of PPD are the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory (BDI) having ten and 21 items, respectively. However, the EPDS and the BDI may be too lengthy to use for quickly screening patients in obstetric, primary care, or pediatric settings.
The Edinburgh Postnatal Depression Scale (EPDS) was designed to screen women for postnatal depression. Cox and Holden (2003) state that the EPDS was not designed to measure anxiety. However, recent emphasis on the importance of recognizing symptoms of perinatal anxiety disorders, coupled with findings in research, have led to the suggestion that the EPDS may be used as a multidimensional tool to screen for anxiety disorders in addition to depression during the perinatal period (Matthey et al, 2012).
A significant number of women experience anxiety symptoms during pregnancy, with about 8.5% of women meeting criteria for generalized anxiety disorder. Other anxiety disorders are less common. The estimated prevalence of panic disorder during pregnancy is 1-2%. The estimated prevalence of obsessive-compulsive disorder is 0.2-1.2%. While we use certain tools, including the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression during pregnancy, what are the best tools for indentifying women with clinically significant anxiety symptoms?
There are many approaches to predicting which women are likely to develop postpartum depression (PPD). Most of these utilize standardized questionnaires and/or screening by health care providers. While these approaches may be effective, they tend to be costly and labor-intensive. A new study pilots the use of social media in predicting which women at risk for postpartum mood disorders.
This is a topic we do not typically cover on our site, but it is clearly an important one. The U.S. Preventive Services Task Force (USPSTF) has updated its recommendations on screening for family and intimate partner violence (IPV). These guidelines, published in the Annals of Internal Medicine, recommend that all women of reproductive age be screened for intimate partner violence. The review provides some information on which screening instruments to use and reviews interventions to reduce the risk of IPV.
In our weekly clinical rounds, we recently discussed how motherhood is such a unique and personal experience for each woman. Often it is assumed that this transition into a new role is easy when for many it is not. How we assess a woman's experiences during the postpartum period is often limited to just her mood. I recently came across a new self-report instrument, The Being a Mother Scale (BaM-13) developed by Stephen Matthey which attempts to assess the “wider domain of the woman’s experience of motherhood” rather than just the presence or absence of a postpartum mood disorder.
While most agree that there is a need for improved detection of anxiety and mood disorders in pregnant and postpartum women, there remain questions regarding the best instruments to use for screening. The Edinburgh Postnatal Depression Scale (a questionnaire consisting of 10 items) has long been used to screen women for postpartum depression (PPD); however, it is unclear how well these questions could be incorporated into larger surveillance programs, such as the CDC-sponsored Pregnancy Risk Assessment Monitoring System (PRAMS) which was designed to assess health behaviors and to screen for health problems, including depression and anxiety, in pregnant and postpartum women.
In 2009, the Australian government launched the National Perinatal Depression Initiative (NPDI) in order “to improve the prevention and early detection of antenatal and postnatal depression and to provide better support and treatment for expectant and new mothers experiencing depression.” Its scope is very much like the MOTHERS Act, which became law in the United States in 2010. Both initiatives seek to increase public awareness of perinatal depression, to provide support and treatment for pregnant and postpartum women with depression, to fund research in this area, and to implement training of health care professionals.
In a recent retrospective cohort study, data collected from linked records from the Women's and Children's Health Network in South Australia were used to investigate neonatal outcomes in children exposed prenatally to selective serotonin reuptake inhibitors (SSRIs). Women were included in this study if they gave birth to a singleton, live-born infant between September 2000 and December 2008 (n = 33,965).
Over the past few years, there has been a push to screen women for depression both during pregnancy and the postpartum period. While there have been various initiatives mandating screening, there remain questions regarding the optimal timing of screening and the best screening tools to use.
