Postpartum depression (PPD)

This is Quality & Safety Initiatives
March 18, 2019
Postpartum Visit
March 18, 2019

Postpartum depression (PPD)

Postpartum depression (PPD) is a major depressive disorder that occurs up to one year after birth (Hackley & Kriebs, 2017). Common symptoms of postpartum depression include: anhedonia; sleep disturbance; feelings of loneliness, isolation, or guilt; poor concentration; anxiety; and somatic complaints (Hackley & Kriebs, 2017). Mothers with postpartum depression are also less responsive to their infants and often need help caring for their infant (Hackley & Kriebs, 2017). Studies have shown that postpartum depression can impact child development, behaviors in childhood, and children’s cognitive function (Hackley & Kriebs, 2017).

The Edinburgh Postnatal Depression Scale (EPDS) is the screening tool used at my preceptor’s clinic to assess for postpartum depression. Hackley and Kriebs (2017) state that because postpartum depression has bimodal peaks at 2 and 6 months, the optimal time to screen for postpartum depression is between 2 weeks and 6 months postpartum. The American College of Obstetricians and Gynecologists (ACOG) recommends screening at the patient’s 6-week comprehensive postpartum visit (ACOG, 2018). However, because postpartum depression can occur at any time, studies and the American Academy of Pediatrics (AAP) are now supporting the use of EPDS screenings for mothers at the 2 month, 4 month, and 6 month well child visits (Emerson, Mathews, & Struwe, 2018).

The cutoff score for depression on the EPDS ranges from 9 to 13. The AAP (n.d.) recommends women with a score of 9 or more be further evaluated for depression. A score of more than 12 is considered likely for postpartum depression (Hackley and Kriebs, 2017). Women with these scores should be clinically evaluated, started on treatment, or referred to a a mental health clinician (Hackley and Kriebs, 2017). A score of less than 9 should not rule out depression if clinical suspicion of PPD is present. Any woman indicating suicidal thoughts on the EPDS or during the comprehensive clinical exam should be immediately assessed to determine if hospitalization is needed (Hackely & Kriebs, 2017). For those at high risk, the patient should be taken to the emergency room (Hackley & Kriebs, 2017).

References

AAP. (n.d.). Edinburgh postnatal depression scale. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Documents/Postnatal%20Depression%20Scale.pdf

ACOG. (2018). Screening for perinatal depression. American College of Obstetricians and Gynecologists, 132(5), 208-212. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co757.pdf?dmc=1&ts=20190310T2001493232

Emerson, M., Mathews, T., & Struwe, L. (2018). Postpartum depression screening for new mothers at well child visits. American Journal of Maternal/Child Nursing, 43(3), 139-145. doi: 10.1097/NMC.0000000000000426

Hackley, B. K., & Kriebs, J. M. (2017). Primary care of women(2nd ed.). Burlington, MA: Jones & Bartlett Learning.