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Perinatal Depression is Another Concern for Women
Adapted from Women’s Health USA 2005

While recent research indicates that depression is a major cause of disability among women, perinatal depression is an even larger concern for expectant mothers. Women’s Health USA 2005 found that even though there is little evidence that depression rates during pregnancy are higher than at other points in a woman’s life, some women may be particularly vulnerable to both major and minor depression during pregnancy and the postpartum months.

Perinatal depression includes major depressive episodes as well as minor depressive episodes which are less severe but still impairing. These episodes begin during pregnancy or within the first 12 months after delivery (postpartum period). The exact prevalence of perinatal depression is unknown, but estimates range from 6.5 to 12.9% of new mothers. Many women continue to suffer from depressive episodes that began prior to pregnancy.

Healthcare providers offering psychosocial support and counseling to pregnant women at risk of depression is effective in decreasing symptoms of depression but little is known about the specific risk factors for perinatal depression or the warning signs that providers should watch for. With training, physicians can screen women accurately for major depression alone, but screening for minor depression is more difficult.

Previous studies have shown that postnatal depression—a distressing disorder more prolonged than the "blues" which occurs in the first week after delivery but less severe than puerperal psychosis—affects at least 10% of women and that many depressed mothers remain untreated. These mothers may cope with their baby and with household tasks, but their enjoyment of life is seriously affected and it is possible that there are long-term effects on the family.

The Edinburgh Postnatal Depression Scale (EPDS) has been developed to assist primary care health professionals to detect mothers suffering from postnatal depression; The EPDS was developed at health centers in Livingston and Edinburgh. It consists of ten short statements; the mother responds to one of four possible answers closest to how she has been feeling during the previous week. Most mothers complete the scale without difficulty in less than 5 minutes.

The validation study showed that mothers who scored above threshold 92.3% were likely to be suffering from a depressive illness of varying severity. Nevertheless the EPDS score should not override clinical judgment. A careful clinical assessment should be carried out to confirm the diagnosis. The scale indicates how the mother has felt during the previous week and in doubtful cases it may be usefully repeated after 2 weeks. The scale will not detect mothers with anxiety neuroses, phobias or personality disorder.

The Edinburgh Postnatal Depression Scale
To complete this set of questions, mothers should circle the number next to the response which comes closest to how they have felt IN THE PAST 7 DAYS.

1. I have been able to laugh and see the funny side of things.

• 0   As much as I always could
• 1   Not quite so much now
• 2   Definitely not so much now
• 3   Not at all

2. I have looked forward with enjoyment to things.

• 0   As much as I ever did
• 1   Rather less than I used to
• 2   Definitely less than I used to
• 3   Hardly at all

3. I have blamed myself unnecessarily when things went wrong.

• 3   Yes, most of the time
• 2   Yes, some of the time
• 1   Not very often
• 0   No, never

4. I have been anxious or worried for no good reason.

• 0   No, not at all
• 1   Hardly ever
• 2   Yes, sometimes
• 3   Yes, very often

5. I have felt scared or panicky for no very good reason.

• 3   Yes, quite a lot
• 2   Yes, sometimes
• 1   No, not much
• 0   No, not at all

6. Things have been getting on top of me.

• 3   Yes, most of the time I haven't been able to cope at all
• 2   Yes, sometimes I haven't been coping as well as usual
• 1   No, most of the time I have coped quite well
• 0   No, I have been coping as well as ever

7. I have been so unhappy that I have had difficulty sleeping.

• 3   Yes, most of the time
• 2   Yes, sometimes
• 1   Not very often
• 0   No, not at all

8. I have felt sad or miserable.

• 3   Yes, most of the time
• 2   Yes, quite often
• 1   Not very often
• 0   No, not at all

9. I have been so unhappy that I have been crying.

• 3   Yes, most of the time
• 2   Yes, quite often
• 1   Only occasionally
• 0   No, never

10. The thought of harming myself has occurred to me.

• 3   Yes, quite often
• 2   Sometimes
• 1   Hardly ever
• 0   Never

The total score is calculated by adding together the numbers you circled for each of the 10 items. The higher the score, the more likely it is that the person completing the questionnaire is distressed and may be depressed.

Scores provide only a rough guide as to whether a woman has postnatal depression. A more detailed scoring guide can be found at www.dbpeds.org.

For more information on the resources and programs listed above, please use the following resources:

• To refer a Medicaid insured pregnant client to the Healthy Together!…Healthy Additions program contact Kim Franchi, RN, at 1-888-545-1710 ext. 7067.
•  To refer a pregnant client to Best Beginnings contact your local Public Health Office.
• To learn more about HBWW program contact Deb Hamilton, WDH Perinatal Systems Manager, Women’s Health Coordinator at 307-777-7944.