Screening Pregnant Women for Depression

320px-Mother_Kissing_Baby by Vera Kratochvil.jpg

Despite what the ads on television show, not every woman who finds herself pregnant is deliriously happy. There are lots of reasons why that might be so, and lots of reasons why a woman might find herself depressed during pregnancy, including financial pressures, lack of partner or family support, health issues, hormonal shifts, concerns about employment, and unplanned or undesired pregnancies.

Perinatal Depression

Perinatal depression encompasses all experiences of depression during the pregnancy and for a 12 month period following delivery. Studies have shown that as many as one in seven women experience some form of depression during this period.

Types of Perinatal Depression

  • Prenatal Depression occurs during the pregnancy, and is experienced by 10 to 20 percent of pregnant women. Symptoms include crying or weepiness, sleep problems and fatigue, loss of enjoyment of activities, anxiety, irritability and lack of attachment to fetus.
  • ”Baby Blues” refer to symptoms that begin usually in the first week after delivery, peak in 3 to 5 days and generally resolve fully within two weeks. Up to 80% of new mothers may experience this. Symptoms include weepiness, sadness, irritability, anxiety, a feeling of being overwhelmed, up and down mood swings, insomnia, frustration and an exaggerated sense of empathy.
  • Postpartum Depression generally begins within the first two to three months after delivery (sometimes immediately after delivery), and does not resolve within two weeks (distinguishing it from “Baby Blues”.) This form of depression is generally experienced by between 10% and 20% of new mothers. Symptoms are many, including all of those noted above, but are experienced more intensely. Additional symptoms include memory loss, lack of interest in caring for one’s self, intense anxiety, including bizarre concerns for the safety of the baby, feelings of inadequacy and guilt, and physical symptoms, including head, chest and stomach pain, heart palpitations, numbness and hyperventilation. At the extreme, the patient might experience suicidal thoughts.
  • Postpartum Psychosis usually begins anywhere from 2 days to 4 weeks after delivery, but may appear at any time within the first postpartum year. Only 1 or 2 of every 1000 new mothers experience this form of depression. With postpartum psychosis the mother can experience visual and auditory hallucinations, delusions of a religious nature and bizarre thoughts of harming the child. Delirium and mania are present, as are paranoia and suicidal or homicidal thoughts.

Screening Recommendations

The existing guidelines, dating back to 2009, recommend screening all adults for depression where resources exist for treatment, but do not address the need for perinatal screening. A proposal recently released by the U.S. Preventive Services taskforce recommends that all pregnant women, or women within a year of giving birth, be screened for perinatal depression. The recommendation is part of a larger proposal that urges that all adults be screened for depression.

The American Congress of Obstetricians and Gynecologists had previously endorsed a similar proposal.

Screening would be in the form of a brief questionnaire. Results of the questionnaire would prompt physicians to recommend a referral to a mental health professional for psychotherapy or medication.

The American Academy of Pediatrics has also proposed screening primary caregivers for symptoms of depression during the perinatal visit and the ongoing schedule of well-baby checkups.

Sources: CNN Health , Healthy NY and American Congress of Obstetrics and Gynecology

Photo image by Vera Kratochvil

 
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