The United States Preventive Services Task Force, a government-appointed health panel, recently recommended that all pregnant women be screened for depression regardless of prior risk factors. The task force notes that using evidence-based screening tests, such as the Edinburgh Postnatal Depression Scale, can help reduce depressive symptoms in women with depression and decrease the prevalence of depression in a given population.
It is important to note that to reduce the effects and prevalence of depression, there is the assumption that additional treatment supports exist, such as counselors specializing in the treatment of depression. A huge benefit to instituting large-scale screening would be the increased likelihood of identifying women who need further evaluation and who could benefit from more focused treatment of depressive symptoms. However, many doctors are not adequately trained in managing mental health issues and may feel unprepared to directly address the threat of postpartum depression if overt risk factors do not exist.
Requiring familiarity with a screening test could help, but more important than a 10-question survey is having an ongoing conversation about mental health and how it may be affected by having a baby. New or expecting parents should familiarize themselves with what is normal and what might be a sign of more severe symptoms. For example, it is natural to experience a precipitous drop in relationship satisfaction following the birth of a child. Attention is focused on the new parenting role at the cost of meeting relationship needs. This is a normal part of the transition to parenthood, and parents can help the adjustment by finding small ways to prioritize their relationship amongst the new parenting responsibilities.
It is also common for mothers to experience the postpartum blues, a form of emotional instability significantly milder than postpartum depression. Research estimates show that up to 85% of new mothers may experience postpartum blues, and it tends to peak within the first week of new motherhood and spontaneously resolve within two weeks of the child’s birth. Symptoms of feeling down or inadequate are mild and tend not to interfere with the mother’s ability to function and care for her child.
Postpartum depression presents the same as would an episode of major depression at any other time in a woman’s life, and it most often occurs within the first four months of a child’s birth. Recent estimates show that one in every seven new mothers likely suffers from postpartum depression. The most severe form of postpartum depression is postpartum psychosis, which although rare, can significantly impact mother and child including a higher risk of infanticide and suicide. The earlier that postpartum depression is diagnosed, the better the prognosis. Thus the benefit that screening could provide in preventing more severe symptoms and in offering better mental health management options.
Further research is needed to determine how often an individual should be screened for depression and how this is influenced by previous episodes of depression. In the case of new mothers, experiences of depression prior to pregnancy are a high risk factor not only for postpartum depression but also for recurring episodes of depression in later life.
If you or someone you know is seeking treatment for postpartum depression, it is important to request resources that aim for long-term benefits and prevention rather than those with a narrower focus on how to get through only the most recent episode. Consult with your physician about what you can do to help prevent depression from affecting your parental and marital relationship, and consider seeing a therapist to help plan for the transition to parenthood.
It does not mean you are a bad parent if you suffer from depressive symptoms following the birth of a child, and the good news is that there are effective treatments available. Take advantage of the resources at your disposal, including the opportunity for regular check-ins with a mental health professional to ensure maintenance of therapy progress.