Brief Screening Can Detect Postpartum Depression

< Sep. 03, 2008 > -- New research has found that three simple questions were just as good as conventional screening for identifying potential postpartum depression among new mothers.

"Postpartum depression is under-diagnosed," says Dr. Adam Aponte, a pediatrician and associate director for recruitment and retention at Mount Sinai School of Medicine in New York City. "We found the fewer the questions, the better. It opens the door for dialogue about how the mom is doing. The last thing you want is a depressed mom. It's important to screen."

Dr. Aponte was not involved in this study, which is published in the medical journal Pediatrics.

Common Problem for New Moms

According to background information included in the study, postpartum depression is the most common problem new mothers confront. The condition is characterized by high levels of anxiety, but screening is not routinely performed due to time and other constraints.

The researchers who performed the study run the Colorado Adolescent Maternity Program (CAMP) for young mothers and their children in Denver.

The center, which has both pre-birth and post-birth services, provided a unique opportunity to follow up with new mothers. The lead author of the study, Dr. Catherine Stevens-Simon, founded CAMP and directed it from 1991 to 2006; she passed away in November 2007.

Depression Scales Utilized

For the study, 199 mothers ages 14 to 26 filled out the standard Edinburgh Postpartum Depression Scale at well-child visits during the first six months after the birth of their child.

The women then filled out three shorter versions of that scale.

A three-item anxiety sub-scale of the Edinburgh Postpartum Depression Scale turned out to be a better screening tool than the two other abbreviated versions which are almost the same as the commonly used Patient Health Questionnaire.

For this sub-scale, new mothers were asked to answer "Yes, most of the time," "Yes, some of the time," "Not very often" or "No, never" to the following statements:

• I have blamed myself unnecessarily when things went wrong.

• I have felt scared or panicky for not very good reason.

• I have been anxious or worried for not very good reason.

Anxiety Contributes to Depression

"We chose these three questions, because other studies have suggested that postpartum depression has a large anxiety component, and those three questions are related specifically to anxiety," says study co-author Jeanelle Sheeder, a senior instructor in pediatrics at the University of Colorado in Denver. "That subscale would probably be reasonable in other populations as well, because a lot of postpartum depression in general is related to that feeling of not knowing what to do and being scared or panicky."

The subscale identified 16 percent more mothers as depressed than the original, longer questionnaire.

"The beauty of three questions is it helps us hone in on what the patient is going through, so we can investigate further," Dr. Aponte says.

Always consult your physician for more information.

More About Postpartum Depression

It is not uncommon for women to experience the "baby blues" during the first days or weeks after delivery (most commonly seen occurring suddenly on the third or fourth day after delivery). The "baby blues" are characterized by the following symptoms, although each woman may experience symptoms differently:

• feelings of disappointment

• crying with no known reason

• irritability

• impatience

• anxiety

• restlessness

It is common for these "baby blues" feelings to go away soon after onset and, in most cases, without treatment.

Much more serious and lasting than the "baby blues," some women experience what is clinically referred to as postpartum depression. The following are the most common symptoms of postpartum depression. However, each woman experiences these symptoms differently. Symptoms include:

• sadness

• anxiety

• hopelessness

• fatigue or exhaustion

• poor concentration

• confusion

• a fear of harming the newborn or yourself

• mood swings characterized by exaggerated highs and/or lows

• diminished libido (sex drive)

• feelings of guilt

• low self-esteem

• uncontrolled crying and with no known cause

• overconcern/overattentiveness for the newborn and/or a lack of interest for the newborn

• appetite changes

• sleep disturbances

• resentment

• memory loss

• feelings of isolation

It is important to note that most women who experience the "baby blues," postpartum depression, postpartum anxiety, and/or postpartum obsessive-compulsive disorder have never experienced these types of symptoms before, especially with such intensity. In any case, it is important for women to seek proper treatment early - not only to ensure that the newborn remains safe and properly cared for, but also so that the mother can resolve these symptoms and experience all the joys of motherhood.

Always consult your physician for more information.