Peripartum mood disturbances screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunita Kumawat, M.B.B.S[2]

Overview

It is critical to identify pregnant females and new mothers with peripartum mood disturbances, because if left unidentified and untreated it may lead to devastating consequences. Several screening tools are available for postpartum depression and for postpartum psychosis, if a patient has risk factors in personal hitory or obstetrical history, then she should visit her physician at the scheduled time for the assessment of mental health. There is no specific guideline for screening of postpartum blues.

Screening

Screening of peripartum mood disturbances includes:

• Woman at-risk for postpartum psychosis should see a psychiatrist even before delivery to discuss treatment options to prevent illness during the delivery and postpartum period.
• In the first 2-4 weeks postpartum, the woman and her family should contact a physician if they find any of these symptoms,like
  • Confusion
  • Strange beliefs
  • Mood Swings
  • hallucinations in the new mother.
• 6-week obstetrical follow-up appointment, it is highly recommended that physicians should inquire about symptoms of postpartum psychosis.
• If the patient expresses red flags like difficulty caring for her child, confusion, poor self-care or threats to harm herself or others, a psychiatric referral should be made as soon as possible.

Depression Screening Tools

• A variety of depression screening tools are available, their specificity ranges from 77% to 100%, but sensitivity varies and is the deciding factor in choosing the depression screening tool.
• The most sensitive tools are
  • Edinburgh Postnatal Depression Scale
  • Postpartum Depression Screening Scale
  • Patient Health Questionnaire-9.

Other less sensitive and not so commonly used screening tools are given in the table below

Depression screenings tools and their Sensitivity/Specificity

Screening tool	Sensitivity/Specificity
Edinburgh postnatal depression scale	Sensitivity:59-100%, Specificity:49-100%
Postpartum Depression Screening Scale	Sensitivity:91-94%, Specificity:72-98%
Patient Health Questionnaire-9	Sensitivity:75%, Specificity:90%
Beck Depression Inventory	Sensitivity:47.6-82%, Specificity:85.9-89%
Beck Depression Inventory-II	Sensitivity:56-57%, Specificity:97-100%
Center for Epidemiologic Studies Deppression Scale	Sensitivity:60%, Specificity:92%
Zung Self Rating Depression Scale	Sensitivity:45-89%, Specificity:77-88%