Co-Director Kathryn Emerick, MD
photo: Jamie Manser
Perinatal Mood and Anxiety Disorders (PMADs) impact one in five pregnant people, making them the most common complication of pregnancy and one of the most underdiagnosed. Screening for PMADs is an essential tool for accurately diagnosing and implementing critical treatment. In 2015, the American College of Obstetricians and Gynecologists (ACOG) recommended screening pregnant people once during the perinatal period. However, this recommendation misses important chances to treat these disorders during pregnancy and mitigate the risks associated with untreated mental illness for both mom and baby.
In a study by Wisner, et al., that evaluated women who screened positive for depression in the postpartum period, 27% were experiencing depressive symptoms prior to pregnancy and 33% during pregnancy. This means that 60% of postpartum depression cases in this study were actually of perinatal onset and could have been treated prior to delivery, reducing risks as well as human suffering. A more encompassing and effective strategy is to screen pregnant people at the first prenatal visit to catch symptoms that were present prior to pregnancy, to assess for development of new symptoms during pregnancy, and to screen for postpartum mood and anxiety symptoms again during the postpartum period. In response to the worsening maternal mental health crisis, ACOG adopted these recommendations in 2023.
There are a variety of valuable screening tools for assessing mood and anxiety symptoms. If you can only use one, the Edinburgh Post Partum Depression Scale (EPDS) is the one most often preferred. With its ten questions, the EPDS is succinct and assesses for depression, suicidality and has a subscale for anxiety. The EPDS is also widely available in many different languages. The EPDS should be administered in a setting that normalizes and creates space for perinatal mental health concerns, be made available in the patient’s native language, and allow the patient to complete it in privacy. A score above ten on the EPDS is considered positive and should be followed up by a full psychosocial evaluation and discussion(s) about treatment options.
Download the EPDS in English and Spanish.
References
Gavin NI, Gaynes BN. Perinatal depression A systematic review of prevalence and incidence. Obstetrics & Gynecology. 12/2005; 106(5 Pt 1): 1071-83.
Wisner KL: Perinatal mental illness: definition, description and etiology. Best Pract Res Clin Obstet Gynaecol:2014; 18(1):3-12.
Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum, Obstetrics & Gynecology 141(6):p 1232-1261, June 2023. DOI: 10.1097/AOG. From https://journals.lww.com/greenjournal/fulltext/2023/06000/screening_and_diagnosis_of_mental_health.35.aspx