Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice

Abstract

Background: Postpartum depression occurs in 10% to 20% of women who have recently given birth, but fewer than half of cases are recognized. The purpose of this review is to discuss the potential benefit of mass screening for improving postpartum depression recognition and outcomes.Methods: A review of the literature was conducted by searching MEDLINE, using the key words "depression," "postpartum depression," and "mass screening." The Cochrane database was also searched for reviews on depression and postpartum depression.Results: Opportunities for routine postpartum depression screening include mothers' postpartum office visits and their infants' well-child visits. Although several depression screens have been used in postpartum women, additional studies using large representative samples are needed to identify the ideal screening tool. Depression screening plus "high-risk" feedback to providers improves the recognition of depression. However, for screening to positively impact clinical outcomes, it needs to be combined with systems-based enhanced depression care that provides accurate diagnoses, strong collaborative relationships between primary care and mental health providers, and longitudinal case management, to assure appropriate treatment and follow-up. Depression is common and costly, particularly for women in their childbearing years. The World Health Organization has identified major depression as the fourth leading cause of burden among all diseases, and the leading cause of years lived with disability. Conclusions: Postpartum depression screening improves recognition of the disorder, but improvement in clinical outcomes1 It is estimated that depression costs the United States $30 billion to $50 billion in lost productivity and direct medical costs each year.2 By 2020, depressive illness is expected to be the second leading cause of disability in the world.3 The burden is greatest for women, with a lifetime risk for major depressive disorder of 20% to 25%, approximately twice the 7% to 12% rate seen with men. 4 In the first 3 months after childbirth, 14.5% of women have a new episode of major or minor depression, 5 and 10% to 20% of mothers are believed to suffer with depression sometime during their postpartum course, 6 making postpartum depression the most common serious postpartum disorder.There is some controversy about whether rates of depression increase after delivery, and whether postpartum depression is a distinct entity from nonpostpartum depression. A British case-control study of mothers from 4 general practices found a 3-fold higher incidence of depression within 5 weeks after childbirth.7 Similarly, a Norwegian study comparing postpartum with nonpostpartum women found a 1.8-fold greater risk for depression in postpartum women.8 However, other researchers have not found the risk of depression to be an higher in postpartum women, compared with other young women, suggesting that postpartum depression may not be a distinct condition but merely major depression recognized at a time of potentia...

Diagnosing postpartum depression in a mother of developmentally delayed infant: a case report

“…Although postpartum depression affects 10%-15% of women after delivery, less than half of the cases are diagnosed in clinical practice. 3 Moreover, recent evidence indicates that only limited number (18%) of women seek treatment for their depressive complaints during pregnancy and postpartum period. 5 There is good evidence that postpartum depression is associated with disturbed maternal-new-born attachment, disturbed mother-infant interaction, cognitive and language development delays in baby, negative parenting practices, troubles in breastfeeding, 6 increased vulnerability of the mother to poor quality of life, depression among fathers.…”

“…2 Women are susceptible to mental disorders during reproductive years and risk factors for developing postpartum depression include having a history of mood disorders, depression and anxiety symptoms during pregnancy, stressful life events and a family history of psychiatric disorders. 3 Postpartum depression might have negative consequences on mother's quality of life, as well as the other family members and the baby. In this article, we will present a clinical case of a baby that highlights common clinical challenges in diagnosing postpartum depression in the mother and try to raise the awareness of physicians for postpartum depression in mothers when examining the baby.…”

Why should we screen for perinatal depression? Ten reasons to do it

“…Because of the opportunity, given that there is a large number of convenient opportunities for routine screening in the perinatal period, when the contact with health professionals is much increased [83].…”

Introduction of More Editorial Board Members and the Most Frequently Read Articles in 2008

“…The Institute provides independent, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large (http://www.iom.edu/CMS/AboutIOM.aspx). 4 and postpartum depression screening 5 ; both are problems frequently seen in family medicine. Figure 1 illustrates both the number of total access events and full-text HTML and PDF accesses for 2008; a new issue is published bimonthly and is also noted.…”