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UNIVERSAL SCREENING FOR PERINATAL DEPRESSION
OBJECTIVES
Identify the scope of perinatal mood and anxiety disorders Establish
the necessity for universal depression screening
Know how depression screening works (EPDS)
PERINATAL PSYCHIATRIC DISORDERS (PPD)
An array of serious mood and anxiety disorders occurring before
and after childbirth Single most frequent serious complication of
pregnancy
POSTPARTUM MOOD DISORDERS
Incidence;
- Occurs in 20% of all pregnancies
- 800,000 cases per year in U.S.
- A minimum of 3 % commit suicide
- Depression in women is the second leading cause of medical
morbidity worldwide
- Early intervention in the treatment of mothers is primary
prevention for their babies
- Illness affects marriages, and the other children
HEALTH CARE GAP
Under-recognized:
- 80% of patients are undiagnosed
- Only 13% of patients receive treatment
- Over 90% have an excellent outcome with combined therapy,
medication and/or psychotherapy
- If untreated, 50% of patients will still be depressed after
one year
- The best clinician, who has the time and knows all the risk
factors, will detect only 40% of cases
CONSEQUENCES OF UNTREATED DEPRESSION
- Disrupts family and marital life
- Increases other healthcare costs
- Can progress to psychosis with risk of suicide or homicide
- Produces cognitive and behavioral changes in baby
- Triples the rate of depression in offspring
BARRIERS TO DIAGNOSIS
- Provider's barriers to diagnosis
- Fear of lawsuits
- Time constraints
- Symptoms appear physical
- Patients are very reluctant to reveal how
they are actually doing
- In pediatrics, the baby is the focus and
the mother is not the doctor's patient
- Discomfort with dealing with intense emotion
and accompanying feelings of helplessness
BARRIERS TO DIAGNOSIS
Mother's barriers
- Shame
- Stigma of mental illness
- Sense of personal failure as a mother
- Fear that their baby will be taken
away
- Guilt that they cannot relate to their
babies
DEPRESSION SCREENING
- Detects nearly all patients who are depressed
- Does not have false negatives
- Can be done in a wide variety of settings by many different
kinds of personnel
- Must be done in primary care settings
- Insures that affected patients are identified
EDINBURGH POSTPARTUM DEPRESSION SCALE (EPDS)
- Easily administered
- Inexpensive
- Can be self administered
- Only 10 questions
- Easily scored
- Clear dispositional protocol
TREATMENT OF PERINATAL DEPRESSION
- Treatment is very effective, > 90%
Components:
- Psychotherapy
- individual
- marital, group and family therapy
- Medication
- Safe, therapeutic and preventive during pregnancy and lactation
- Psychosocial interventions
- Peer support groups
- Training patients and family members
SUMMARY
- Perinatal mood disorders are of catastrophic proportion
- The vast majority are not diagnosed or treated
- Universal depression screening in primary care settings detects
almost all cases
- Treatment is very effective
ADDITIONAL RESOURCES
Family Mental Health Institute
202-496-4977
Website:
www.ppdhope.com
Toll Free National Warmline
1-866-PPD-HOPE
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