Peripartum mood disturbances screening
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It is critical to identify pregnant females and new mothers with peripartum mood disturbances, because if left unidentified and untreated it may lead to devastating consequences. Several screening tools are available for postpartum depression and for postpartum psychosis, if a patient has risk factors in personal hitory or obstetrical history, then she should visit her physician at the scheduled time for the assessment of mental health. There is no specific guideline for screening of postpartum blues.
Pregnancy and postpartum are the most vulnerable times for mothers, fathers , and children, with psychiatric hospitalizations rising faster than at any other period in a woman's life. In the United States, postpartum depression is the most underdiagnosed obstetric problem.Comprehensive screening of all pregnant and postpartum women is critical since the burden of depression and other mental health problems is high for mothers and their children, and is often ignored. Despite growing awareness of the prevalence of prenatal mental health issues and their potential harmful consequences for women, babies, and families, perinatal mental health is far too often misdiagnosed, undertreated, or untreated.
- The first prenatal appointment
- During the second trimester, at least once
- During the third trimester, at least once
- Obstetrical visit six weeks after delivery (or at first postpartum visit)
- In Obstetric and primary care settings, screening at 6 and/or 12 months is recommended.
Woman at-risk for postpartum psychosis should see a psychiatrist even before delivery to discuss treatment options to prevent illness during the delivery and postpartum period. In the first 2-4 weeks postpartum, the woman and her family should contact a physician if they find any of these symptoms,like
- Strange beliefs
- Mood Swings
- Hallucinations in the new mother.
- 6-week obstetrical follow-up appointment, it is highly recommended that physicians should inquire about symptoms of postpartum psychosis.
- If the patient expresses red flags like difficulty caring for her child, confusion, poor self-care or threats to harm herself or others, a psychiatric referral should be made as soon as possible.
Depression Screening Tools
- A variety of depression screening tools are available, their specificity ranges from 77% to 100%, but sensitivity varies and is the deciding factor in choosing the depression screening tool.
- The most sensitive tools are
- Edinburgh Postnatal Depression Scale
- Postpartum Depression Screening Scale
- Patient Health Questionnaire-9.
Other less sensitive and not so commonly used screening tools are given in the table below
|Edinburgh postnatal depression scale||Sensitivity:59-100%, Specificity:49-100%|
|Postpartum Depression Screening Scale||Sensitivity:91-94%, Specificity:72-98%|
|Patient Health Questionnaire-9||Sensitivity:75%, Specificity:90%|
|Beck Depression Inventory||Sensitivity:47.6-82%, Specificity:85.9-89%|
|Beck Depression Inventory-II||Sensitivity:56-57%, Specificity:97-100%|
|Center for Epidemiologic Studies Deppression Scale||Sensitivity:60%, Specificity:92%|
|Zung Self Rating Depression Scale||Sensitivity:45-89%, Specificity:77-88%|
- Sit D, Rothschild AJ, Wisner KL (May 2006). "A review of postpartum psychosis". J Womens Health (Larchmt). 15 (4): 352–68. doi:10.1089/jwh.2006.15.352. PMC 3109493. PMID 16724884.
- Davidson JR, Meltzer-Brody SE (1999). "The underrecognition and undertreatment of depression: what is the breadth and depth of the problem?". J Clin Psychiatry. 60 Suppl 7: 4–9, discussion 10–1. PMID 10326869.
- "Postpartum mental health screening and diagnosis by obstetrician–gynecologists: Journal of Psychosomatic Obstetrics & Gynecology: Vol 32, No 1".
- "Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice | American Board of Family Medicine".
- "Screening for Depression During and After Pregnancy - ACOG".