Postpartum depression (PPD) is fairly common, with a prevalence of 10-15%. PPD can occur anytime in the first year after delivery. The postpartum year is one of the highest risk periods for first-onset depression for women with approximately 50% of women who will have a depressive disorder in their lifetime experiencing their first episode of depression during that time. In addition 25% of women with a history of Major Depressive Disorder will experience PPD and 50% of women who have had PPD will have a recurrence. In addition to depressive symptoms, women with PPD will typically present with prominent anxiety symptoms that involve distressing and intrusive thoughts about infant safety and feelings of guilt and inadequacy about mothering. Untreated PPD can have detrimental effects on the mother-baby bond and can lead to social-emotional problems and language delays in the children.
These types of symptoms can lead to stigma feelings of shame and therefore make it hard for a woman to feel comfortable disclosing her symptoms to her doctor, to avoid feeling judged.
The U.S. Preventive Task Force, the American Academy of Pediatrics and the American College of Obstetrics and Gynecology all recommend screening women in the postpartum period for depression. The Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale are useful screening tools. The key to detect as many cases of PPD as possible is to have repeated screenings. More than 10% of women who have a negative screen at 4-12 weeks postpartum were found to be high risk 6-12 months later. And it is important to conduct the screening in an open and comfortable way, helping mothers understand that PPD is very common and that it is not the mother’s fault.
The other piece that is important is making sure that women with a positive screen go on to have a complete assessment to determine if they do indeed have PPD and then are linked to appropriate treatment. Many identified cases of PPD end up being lost to follow up because of lack of linkage or, again, the mother’s worry about stigma and judgment. One option that is growing in popularity is co-location of behavioral health in the primary care setting.
It can be scary and confusing to mothers who do not feel depressed early on in the postpartum period to go on to develop symptoms of PPD (depressed mood, lack of interest in activities that they normally enjoyed, constant worry and fatigue, to name a few common ones) later in the postpartum period. But is not uncommon. And it argues the point that it is important to conduct screenings at intervals throughout the postpartum period.
Appropriate interventions range from individual and supportive therapy to home health nursing visits to support groups, and in some cases, medication. SmartCare BHCS is available to help provide specific recommendations for individual cases. It is our hope that this primer on postpartum depression helps primary care providers feel more comfortable with assessment and treatment recommendations for this common mental health presentation.
Edinburgh Postnatal Depression Scale: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Documents/Postnatal%20Depression%20Scale.pdf