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{{CMG}}; {{AE}}{{Sunita}}
{{CMG}}; {{AE}}{{Sunita}}


==Overview==
==Overview==  
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.


There is insufficient evidence to recommend routine screening for [disease/malignancy].  
==Screening==
[[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.<ref name="pmid16724884">{{cite journal |vauthors=Sit D, Rothschild AJ, Wisner KL |title=A review of postpartum psychosis |journal=J Womens Health (Larchmt) |volume=15 |issue=4 |pages=352–68 |date=May 2006 |pmid=16724884 |pmc=3109493 |doi=10.1089/jwh.2006.15.352 |url=}}</ref> In the United States, [[postpartum depression]] is the most underdiagnosed [[obstetric]] problem.<ref name="pmid10326869">{{cite journal |vauthors=Davidson JR, Meltzer-Brody SE |title=The underrecognition and undertreatment of depression: what is the breadth and depth of the problem? |journal=J Clin Psychiatry |volume=60 Suppl 7 |issue= |pages=4–9; discussion 10–1 |date=1999 |pmid=10326869 |doi= |url=}}</ref>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.<ref name="urlPostpartum mental health screening and diagnosis by obstetrician–gynecologists: Journal of Psychosomatic Obstetrics & Gynecology: Vol 32, No 1">{{cite web |url=https://doi.org/10.3109/0167482X.2010.547639 |title=Postpartum mental health screening and diagnosis by obstetrician–gynecologists: Journal of Psychosomatic Obstetrics & Gynecology: Vol 32, No 1 |format= |work= |accessdate=}}</ref>
 
*The first [[prenatal]] appointment
*During the [[Trimester|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


OR
* Confusion
* Strange beliefs


According to the [guideline name], screening for [disease name] is not recommended.
* [[mood swings|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.


OR


According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
<u>Depression Screening Tools</u><ref name="urlPostpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice | American Board of Family Medicine">{{cite web |url=https://www.jabfm.org/content/20/3/280/tab-article-info |title=Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice &#124; American Board of Family Medicine |format= |work= |accessdate=}}</ref>
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].


OR
*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.


According to the [guideline name], screening for [disease name] is not recommended.


OR
Other less sensitive and not so commonly used screening tools are given in the table below<ref name="urlScreening for Depression During and After Pregnancy - ACOG">{{cite web |url=https://web.archive.org/web/20141102112919/http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Depression-During-and-After-Pregnancy |title=Screening for Depression During and After Pregnancy - ACOG |format= |work= |accessdate=}}</ref>


According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with:
{| class="wikitable"
*[Condition 1]
|+Depression screenings tools and their Sensitivity/Specificity
*[Condition 2]
|-
*[Condition 3]
!Screening tool!!Sensitivity/Specificity
|-
|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%
|}<br />


==References==
==References==
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[[Category:Primary care]]
[[Category:Obstetrics]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Psychiatry]]

Latest revision as of 19:54, 5 August 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunita Kumawat, M.B.B.S[2]

Overview

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.

Screening

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.[1] In the United States, postpartum depression is the most underdiagnosed obstetric problem.[2]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.[3]


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

  • Confusion
  • Strange beliefs


Depression Screening Tools[4]

  • 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[5]

Depression screenings tools and their Sensitivity/Specificity
Screening tool Sensitivity/Specificity
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%


References

  1. 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.
  2. 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.
  3. "Postpartum mental health screening and diagnosis by obstetrician–gynecologists: Journal of Psychosomatic Obstetrics & Gynecology: Vol 32, No 1".
  4. "Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice | American Board of Family Medicine".
  5. "Screening for Depression During and After Pregnancy - ACOG".

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