New mothers often not asked about depression

Jun 1 2007

The majority of doctors in North Carolina do not probe for signs of postpartum depression in new mothers, according to a survey conducted by researchers at the University of North Carolina at Chapel Hill.

Of the 228 physicians responding to the survey who said they had seen women for postpartum visits in the previous three months, 79 percent said they were unlikely to formally screen the patients for depression. An estimated 13 percent of new mothers are affected by postpartum depression. The study will be published June 6, 2007 in the North Carolina Medical Journal .

“We believe that it is very important that physicians work some type of depression screening into postpartum visits,” said Betsy Sleath, lead author of the study and a professor in UNC's School of Pharmacy.

“And perhaps even more important, women shouldn't be afraid or embarrassed to raise this issue with their doctor. We're expected by society to be happy when we have a child so sometimes it's hard to talk about the fact that women feel sad, or that it's hard being a new mother,” Sleath said.

The Patient Health Questionnaire and the Edinburgh Postnatal Depression Scale are formal tools physicians and others can use to determine a woman's risk of postpartum depression. But Dr. Bradley Gaynes, one of the study's co-authors and a psychiatrist with UNC Health Care, said that checking for signs of depression doesn't require a formal screen; it could be as simple as asking a new mother two questions:

• Has your interest in your usual activities changed?
• Do you feel depressed or hopeless?

“We recognize that physicians must cope with many demands on their time,” Gaynes said. “But depression is one of the most common postpartum complications, and a postpartum depression needs to be identified before it can be treated. We encourage clinicians to always check for signs of depression during postpartum visits. These questions represent the core symptoms of a major depressive disorder.”

According to the study, only 43 percent of physicians said they were almost certain to ask whether a woman felt down, depressed or hopeless; only 27 percent said they were almost certain to ask about a woman's interest in her usual activities.

“Depression during the perinatal period can have devastating consequences, not only for the women experiencing it but also for the women's children and family. It's a disease that affects more than just the new mother,” Gaynes said.

Postpartum depression is thought to be caused by changes in hormone levels that occur after pregnancy, Gaynes said. Every woman has a risk of postpartum depression during the first several months after childbirth, miscarriage or stillbirth. A woman is at greater risk if she has a history of depression; has poor support from her partner, family or friends; or is under significant additional stress, he says.

Symptoms of postpartum depression include extreme fatigue, loss of pleasure in daily life, sleeplessness, sadness, tearfulness, anxiety, hopelessness, feelings of worthlessness and guilt, irritability, appetite change and poor concentration.

For an example of the Edinburg Postnatal Depression Scale, visit: http://www.wellmother.com/articles/edinburgh.htm
For an example of the Patient Health Questionnaire, visit: http://www.pfizer.com/pfizer/download/do/phq-9.pdf
The study will be available June 6, 2007 on: http://www.ncmedicaljournal.com