While postpartum depression (PPD) is typically considered to be a woman’s illness, a number of studies have suggested that, although men do not experience any of the dramatic physiologic or hormonal changes that go along with pregnancy, new fathers may also suffer from PPD. Several recent studies yield information on how to better identify new fathers at risk for depression.
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?
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.
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.
Postpartum depression is experienced by 10-15% of women and carries risks to both mother and baby. Untreated maternal depression is associated with negative outcomes for children including behavioral problems, cognitive or developmental delays and impaired attachment. Treatment of a mother’s depression can improve not only her own functioning and quality of life, but can improve her children’s symptoms as well (Pilowsky 2008). Given the importance of a mother’s mental health on her baby’s well-being, the American Academy of Pediatrics (AAP) released a recent report which recommends that pediatricians screen mothers for postpartum depression at baby’s one-, two-, and four-month visits (Earls 2010).
While postpartum depression is common among new mothers, our ability to reliably detect this illness remains poor. Recent studies have indicated that most obstetricians report that they screen for postpartum psychiatric problems at routine follow-up visits but typically do not use standardized instruments to assess for postpartum depression. Unfortunately, studies which have measured the success of routine screening suggest that without the use of standardized screening tools like the Edinburgh Postnatal Depression Scale, many women with postpartum depression are not identified.
