Screening for Depression During and After Pregnancy

During and after pregnancy, every aspect of women’s physical health is examined. They are poked, prodded, weighed, and measured. They are advised to avoid raw cheese, caffeine, alcohol, ibuprofen, aspirin, and countless other things that potentially could harm them or their offspring. But women’s mental health during pregnancy and early motherhood rarely receives as much attention as their physical health — an odd focus, considering that postpartum depression is the most common complication of pregnancy. New guidelines issued by the U.S. Preventive Services Task Force (USPSTF), however, may help to ensure that pregnant and postpartum women are screened and, if needed, treated for depression and other mental health disorders.

The USPSTF updated its depression screening guideline in January 2016 to specify that pregnant and postpartum women should be screened for depression. The guideline also calls for primary care providers to have systems in place to refer women to appropriate behavioral health services.

The new guideline acknowledges the scope of a problem that’s infrequently addressed by primary care physicians, obstetricians, and others who work with women during and after pregnancy. Women are most vulnerable to depression and other mood disorders during the post-partum period, but maternal depression can last through a child’s preschool years or longer. One out of five women who gives birth experiences postpartum depression, while 70 to 80 percent of women will have some negative feelings or unnerving mood swings after giving birth. Postpartum psychosis is a serious condition that occurs in about 1 to 2 out of every 1,000 pregnancies, usually within the first two weeks of giving birth.

Signs and symptoms of depression in pregnant and postpartum women may appear any time during pregnancy or within the first year of giving birth. Symptoms vary from woman to woman and may include any of the following:

  • Frequently feeling angry or irritable
  • Not feeling interested in the baby
  • Eating too much or too little
  • Disturbed sleep (beyond being wakened by the baby)
  • Feeling sad
  • Crying easily
  • Feeling guilty, ashamed, or hopeless
  • Not wanting to do things you used to enjoy, and taking no pleasure in them when you do them
  • Thinking about hurting yourself or the baby

Maternal depression can have devastating consequences for parents and children alike. When mothers are depressed, they may not be able to respond to their children’s emotional and physical needs – or to their partners’ needs. Children of depressed mothers may develop cognitive and social delays, social and emotional problems, and long-term behavioral problems. In turn, a child’s developmental delays can increase stress on the family, raising the risk of depression for both parents. These effects seem to be most pronounced during the first year after giving birth, an important period for infants to form secure attachment bonds with their caregivers.

Schultz’s suggestion is feasible, largely because initial screening for depression is straightforward. It generally takes about 10 minutes, and several reliable tests are available. The most commonly used scaled, the Edinburgh Postnatal Depression Scale, consists of 10 simple multiple choice question. The scale has been tested in many settings and has shown to be an accurate tool that allows clinicians to quickly assess women for postpartum depression.

The USPSTF guideline, if implemented well, is likely to help mothers, their children, and their partners, according to Dana Schultz, Senior Policy Analyst for the RAND Corporation. Widespread implementation, Schultz points out, will need to involve screening in many community settings. Screening can occur outside of primary care clinics, such as in early childhood education and intervention centers, preschools, pediatric clinics, and other settings.

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