Early Detection of Postpartum Depressive Symptoms in Mothers and Fathers and Its Relation to Midwives’ Evaluation and Service Provision: A Community-Based Study

Abstract

BackgroundPostpartum parental mental health problems pose a serious risk for child development and often remain undetected in postpartum primary care. Within the framework of the German Midwifes Prevention Study, the aim of this study was to investigate the presence of postpartum emotional distress in mothers and fathers, and the detection of distressed parents by midwives in a primary care setting. We also examined whether a temporal extension of the postpartum midwife care period is associated with greater use of midwife contacts and higher rates of referral to further professional support if needed.MethodsMothers, fathers, and midwives filled out questionnaires at 2 weeks (t1) and 6 months (t2) postpartum. Compared to standard care in the control group (CG), midwives in an intervention group (IG) offered extended postpartum care of 6 months postpartum. Parental psychological distress was assessed using the Edinburgh postnatal depression scale (EPDS). Midwives reported on parental psychological distress as well as the number of postpartum contacts and referrals to additional social- and health-care providers.ResultsBased on their ratings, midwives identified half of mothers and around one-quarter of fathers with elevated depressive symptoms according to the EPDS at t1 and t2. IG mothers used significantly more midwife contacts than CG mothers. IG mothers with high-postnatal psychological distress at t2 used significantly more contacts than mothers with lower levels of distress. IG mothers with high-psychological distress at t2 were referred to additional support services more often than mothers with lower levels of distress.

Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review

“…The use of screening tools were less likely during the early postnatal period where there was a reliance on clinical judgement and this may result in midwives not enquiring appropriately about the woman's psychosocial wellbeing and limiting the opportunity to identify women at risk of PMHPs (Yelland et al, 2007). When no systematic identification strategy is in use Anding et al, (2015) found that based on ratings midwives only identified half of mothers with high EPDS scores and who reported significant postnatal depressive symptoms.…”

There is more to perinatal mental health care than depression: Public health nurses reported engagement and competence in perinatal mental health care

“…The potential implication of relying on selective screening is that women without an obvious presentation will be missed. Similarly, relying only on personal judgement may also result in those with significant risk factors, including those with a history of mental health problems not receiving the support required in the perinatal period (Anding, Röhrle, Grieshop, Schücking, & Christiansen, ; Heneghan, Morton, & DeLeone, ). There is no doubt that the practice of exclusion or selective screening is a reflection of PHNs’ self‐reported lack of knowledge and skill in perinatal mental health compounded by a lack of education and organisational practice guidelines (Higgins et al., ).…”

Barriers to addressing mental health issues in childbearing women in Ghana

“…In recognition of the gravity of mental health issues in childbearing women, professional organizations (National Institute for Health and Care Excellence, 2014) and researchers (Siu et al, 2016) have recommended routine screening to identify women at risk of mental health problems for early intervention. However, empirical evidence suggests that most childbearing women at risk of mental health problems are undetected, undiagnosed and untreated (Anding, Röhrle, Grieshop, Schücking, & Christiansen, 2015;Bayrampour et al, 2017;Fonseca, Gorayeb, & Canavarro, 2015). This observation provides the impetus for studies to explicate factors that can be improved to promote mental and emotional well-being in this vulnerable population.…”