The Efficacy of Postpartum Depression Screening
How effective is postpartum depression screening?
More than one in 10 new mothers is thought to experience significant postpartum depression. The condition has a substantial impact on the whole family, and while effective treatments are available, fewer than half of cases are detected in routine care.
Postpartum depression is typically diagnosed a month to a year after childbirth. Women experience a combination of low mood, fatigue, anxiety, irritability, feelings of being unable to cope and difficulty sleeping. It is distinct from the “baby blues,” which is a short-lasting state of low mood suffered by up to 80 percent of mothers within three to four days following birth.
Postpartum depression is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being diagnostically distinct from major depression, although the manual does contain a “Postpartum Onset” specifier for patients with an onset within four weeks of giving birth.
Formal screening in the U.S. is often carried out using the Edinburgh Postnatal Depression Scale, a 10-item, self-rated instrument also used throughout Europe, New Zealand and Australia. A threshold score of 12.5 was shown in one Australian study to accurately detect major depression. It can be quickly scored, and a woman who meets a threshold score can be assessed in more detail.
Dr. Mike Paulden of the University of York, UK, and colleagues recently investigated the utility of the Edinburgh Postnatal Depression Scale for widespread screening of new mothers. They write on the website of the British Medical Journal that widespread screening via questionnaire “has been advocated but is controversial.”
Universal screening needs to be balanced against a high rate of false positives, that is, women with an incorrect diagnosis of depression. Although the Edinburgh Postnatal Depression Scale is the most frequently researched, and “performs reasonably well,” the team concludes that it “does not represent value for money for the National Health Service.”
Nevertheless, a worrying number of women with postpartum depression are overlooked in primary care clinics. Victoria Hendrick, associate professor at the University of California at Los Angeles, writes, “The mother’s suffering, coupled with the burden that her depression places on the family and the potential detrimental impact on the relationship between mother and child and the child’s cognitive and social development, call for prompt and effective methods of screening for postpartum depression.”