Depression Post Natal

Background

Post Natal Depression (PND) affects approximately 10% of women during pregnancy or after childbirth.

Untreated, PND is associated with several adverse effects including; impaired mother-child bonding, suicide and infanticide, reduced breastfeeding rates, reduced compliance with vaccination schedules and may be associated with cognitive and developmental issues in the child.

Key Points

A Screening programme with access to appropriate support services can prevent or reduce the severity of PND.

There should be a low threshold to use the Edinburgh Post Natal Depression Scale (EDPS).

Screen all women with infants < 6 months with the 2 screening questions:

During the past month, have you often been bothered by feeling down, depressed or hopeless?
During the past month, have you often been bothered by having little interest or pleasure in doing things?

Women are at higher risk of PND if there is a past history of mental health issues or if there are significant social stressors.

Often babies of mothers where there is concern for severe PND or significant social stressors will be admitted under the general paediatrics team for observation and further support.

The CUH Children's Emergency Department and the CUMH Perinatal Mental Health Service are collaborating on a CREC approved quality improvement project to determine whether women within 6 months post partum would benefit from a screening programme for PND in the ED.

EDPS

Using the Edinburgh Post Natal Depression Scale (EDPS)

This is an extensively validated, 10 item, self-reported questionnaire. Responses are scored from 0-3 with a maximum score of 30. The form is to be completed by the mother.

Note: A score of 1 or more for question 10 (self-harm) should prompt a referral to liaison psychiatry in CUH prior to patient discharge.

When to use the EDPS

Use whenever there is concern for possible PND. The following can be used as a guide.

Positive response to preliminary screening questions
- Feeling down?: During the past month, have you often been bothered by feeling down, depressed or hopeless?
- Loss of pleasure?: During the past month, have you often been bothered by having little interest or pleasure in doing things?
OR
Past history of depression or another mental health disorder
OR
Clinical concern based on observations in the ED: Some indicators for using the EDPS might include;
- An unusual level of anxiety about the health of the infant
- Concern over one's ability to look after their infant
- Negative perception of infant temperament and behaviour
- Lack of interest in infant's activities
- Non-adherence to post-natal care
- Frequent visits to the ED or GP

EDPS scoring / actions

Score <5:

No further action. Proceed to manage child according to condition. Place the completed EDPS form in the study folder located within the Children's ED.

Score 5-9:

Provided there is no concern for the welfare of the child or suicide/self-harm in the mother (Look at Q10), give PND handout and advise GP review within 2 weeks if symptoms persist. Place the completed EDPS and consent forms in the study folder located within the Children's ED.

Score of 10+:

Provided there is no concern for the welfare of the child or suicide/self-harm in the mother (Look at Q10), Complete referral form and send to CUMH Perinatal mental health services in an envelope using internal post. Give the handouts on PND and the perinatal Mental Health Service.

When referring a mother who is deemed safe for discharge, send the first page of the duplicate referral form to the CUMH Perinatal Mental Health Service via internal post. Place the carbon copy of the referral form, along with the completed EDPS and Consent form in the study folder located within the Children's ED.

If the mother does not want to participate in the study, please place a consent form with no identifiers on it, in the study folder and indicate in writing that consent was denied.

Post Natal Depression Screening in the ED