Detection and treatment of postnatal depression (perinatal depression or anxiety)

Current Opinion in Psychiatry

Volumn 17, Issue 1, 2004, Pages 21-29

  Matthey, Stephen ^a  

^a SYDNEY SOUTH WEST AREA HEALTH SERVICE   (Australia)

Author keywords

Anxiety; EPDS; New parents; Postnatal antenatal depression; Psychosocial screening

Indexed keywords

DOCOSAHEXAENOIC ACID; THYROXINE;

ANXIETY DISORDER; BEHAVIOR THERAPY; CLINICAL TRIAL; COGNITIVE THERAPY; HUMAN; MATERNAL CARE; MOOD DISORDER; MOTHER CHILD RELATION; PATIENT COUNSELING; PRENATAL SCREENING; PSYCHODYNAMICS; PSYCHOTHERAPY; PUERPERAL DEPRESSION; PUERPERIUM; RATING SCALE; REVIEW; SCREENING;

EID: 4143112569     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-200401000-00005     Document Type: Review

References (96)

1. Newport DJ, Hostetter BA, Arnold A, Stowe ZN. The treatment of postpartum depression: minimizing infant exposures. J Clin Psychiatry 2002; 63 (Suppl 7):31-44.
2. Flores DL, Hendrick VC. Etiology and treatment of postpartum depression. Curr Psychiatry Rep 2002; 4:461-466.
3. Austin MP, Lumley J. Antenatal screening for postnatal depression: a systematic review. Acta Psychiatr Scand 2003; 107:10-17.
4. Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology of postpartum depression. Compr Psychiatry 2003; 44:234-246.
5. Nonacs R, Cohen LS. Depression during pregnancy: diagnosis and treatment options. J Clin Psychiatry 2002; 63 (Suppl 7):24-30.
6. Gamble JA, Creedy DK, Webster J, Moyle W. A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress. Midwifery 2002; 18:72-79.
7. Wisner KL, Parry BL, Piontek CM. Postpartum depression. N Engl J Med 2002; 347:194-199.
8. Austin M-P. Targeted group antenatal prevention of postnatal depression: a review. Acta Psychiatr Scand 2003; 107:244-250.
9. Brown S, Small R, Faber B, et al. Early postnatal discharge from hospital for healthy mothers and term infants [Cochrane review]. In: The Cochrane Library. Oxford: Update Software; 2003.
10. Boath E, Henshaw C. The treatment of postnatal depression: a comprehensive literature review. J Reprod Infant Psychol 2001; 19:215-248.
11. Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR. Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord 2003; 17:461-478.
12. Misri S, Kostaras X. Benefits and risks to mother and infant of drug treatment for postnatal depression. Drug Saf 2002; 25:903-911.
13. Cox J, Holden J, Sagovsky R. Detection of postnatal depression: development of the 10 item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150:782-786.
14. Cox J, Holden J. Perinatal mental health: A guide to the Edinburgh Postnatal Depression Scale (EPDS). London: Gaskell; 2003 This is an essential resource for any service using the EPDS. It provides a thorough review and debate of major clinical and research issues in the use of the EPDS and the detection and management of PND.
15. Beck CT, Gable RK. Postpartum Depression Screening Scale: development and psychometric testing. Nurs Res 2000; 49:272-282.
16. Beck CT, Gable RK. Further validation of the Postpartum Depression Screening Scale. Nurs Res 2001; 50:155-164.
17. Beck CT, Gable RK. Comparative analysis of the performance of the Postpartum Depression Screening Scale with two other depression instruments. Nurs Res 2001; 50:242-250.
18. Callahan JL, Hynan MT. Identifying mothers at risk for postnatal emotional distress: further evidence for the validity of the Perinatal Posttraumatic Stress Disorder Questionnaire. J Perinatol 2002; 22:448-454. This describes an emerging new self-report tool which, by aiming to detect 'emotional distress', could be seen to be moving away from the strictly diagnostic categories of PND and PTSD.
19. Symon A, MacDonald A, Rita D. Postnatal Quality of Life Assessment: introducing the Mother-Generated Index. Birth 2002; 29:40-46. This measure focuses on the concerns of the individual woman, and could thus be a useful clinical tool to complement the 'disorder' approach more often taken.
20. Beck CT. Revision of the Postpartum Depression Predictors Inventory. JOGNN, 2002; 31:394-402. This provides a checklist for clinicians to use in interviews with women antenatally or postnatally. It is based upon 13 risk factors currently identified as being associated with postpartum depression.
21. Austin MP. Psychosocial assessment and management of depression and anxiety in pregnancy. Aust Fam Physician 2003; 32:119-126. This useful paper discusses the importance of routine screening in pregnancy
22. Ross LE, Evans SEG, Sellers EM, Romach MK. Measurement issues in postpartum depression part 2: assessment of somatic symptoms using the Hamilton Rating Scale for Depression. Arch Women Ment Health 2003; 6:59-64. These authors present an interesting discussion of the assessment of somatic symptoms during pregnancy and postpartum.
23. Garcia-Esteve L, Ascaso C, Ojuel J, Navarro P. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Spanish mother. J Affect Disord 2003; 75:71-76. This provides a good example of how the cut-off score for English-speaking women of either 12/13 or 9/10 on the EPDS does not necessarily apply to women from a different culture.
24. Uwakwe R. Affective (depressive) morbidity in puerperal Nigerian women: validation of the Edinburgh postnatal depression scale. Acta Psychiatr Scand 2003; 107:251-259. Although not the main focus of this paper, it highlights the incredibly low detection rate of postnatal mood disorders using routine care in a country with little emphasis of mental health conditions in new mothers.
25. Danaci AE, Dinc G, Deveci A, et al. Postnatal depression in Turkey: epidemiological and cultural aspects. Soc Psychiatry Psychiatr Epidemiol 2002; 37:125-129.
26. Inandi T, Elci OC, Ozturk A, et al. Risk factors for depression in postnatal first year, in eastern Turkey. Int J Epidemiol 2002; 31:1201-1207.
27. Fuggle P, Glover L, Khan F, Haydon K. Screening for postnatal depression in Bengali women: preliminary observations from using a translated version of the Edinburgh Postnatal Depression Scale (EPDS). J Reprod Infant Psychol 2002; 20:71-82. This is an interesting example of some cultural difficulties that can arise when using the EPDS.
28. Regmi S, Stigl W, Carter D, et al. A controlled study of postpartum depression among Nepalese women: validation of the Edinburgh Postpartum Depression Scale in Kathmandu. Trop Med Int Health 2002; 7:378-382. A side issue in this paper, which increases its interest, is that they found no difference in the rates of depression in postpartum and non-postpartum women.
29. Vega-Dienstmaier JM, Mazzotti Suarez G, Campos Sanchez M. Validation of a Spanish version of the Edinburgh Postnatal Depression Scale. Actas Esp Psiquiatr 2002; 30:106-111. A higher EPDS cut-off score for major depression was found (13/14), again showing why the cut-off score for English-speaking women should not simply be used for women from other cultures.
30. Chandran M, Tharyan P, Muliyil J, Abraham S. Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Br J Psychiatry 2002; 181:499-504. Discusses some culture-specific variables that may contribute to PND in Indian women.
31. Chaaya M, Campbell OMR, El Kak F, et al. Postpartum depression: prevalence and determinants in Lebanon. Arch Women Ment Health, 2002; 5:65-72.
32. Mantle F. Developing a culture-specific tool to assess postnatal depression in the Indian community. Br J Community Nurs 2003; 8:176-180. While this measure initially looks promising, with respect to using culturally specific concepts of depression ('dosha'), the actual questions refer to the same symptoms of depression as used in Western cultures.
33. Buist A, Morse CA, Durkin S. Men's adjustment to fatherhood: implications for obstetric hearth care. J Obstet Gynecol Neonatal Nurs 2003; 32:172-180. The authors provide further supportive information that suggests that discussing expectant parents' concerns during antenatal classes may be helpful.
34. Matthey S, Barnett BEW, Kavanagh DJ, Howie P. Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Disord 2001; 64:175-183
35. Dell DL, Halford JJ. Dementia presenting as postpartum depression. Obstet Gynecol 2002; 99:925-928.
36. Stavrou P, Sgouros S. Frontal lobe tuberculoma masquerading as postnatal depression. Br J Neurosurg 2002; 16:74.
37. Weisberg RB, Paquette JA. Screening and treatment of anxiety disorders in pregnant and lactating women. Womens Health Issues 2002; 12:32-36. This is a good discussion of the need to screen for anxiety disorders in pregnancy and postpartum.
38. Dion X. Anxiety: a terrifying facet of postnatal depression. Community Pract 2002; 75:376-380. The author proposes that comorbidity of depression and anxiety is associated with more severe symptom levels of each than in women with just one or the other disorder, and discusses some treatment implications (though note, no original data are provided to support the proposition).
39. Fisher JRW, Feekery CJ, Rowe-Murray HJ. Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit. J Paediatr Child Health 2002; 38:140-145. This important paper conceptualizes, with empirical evidence, how PND in fact comprises three distinct categories of difficulty in women admitted to a mother-baby unit. As such it is one of the few studies to suggest that the diagnosis of PND fails to correctly capture the different difficulties experienced by women.
40. Matthey S, Barnett B, Howie P, Kavanagh DJ. Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 2003; 74:139-147. This paper, by the reviewer, presents empirical evidence that anxiety may not coexist with depression, and that fathers may be more susceptible to experiencing anxiety than depression post-natally.
41. Skari H, Skreden M, Malt VF, et al. Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth: a prospective population-based study of mothers and fathers. BJOG 2002; 109:1154-1163. This interesting study looked at the rates of depression, anxiety and PTSD-like symptoms. The paper is also of interest because it discusses the concepts of distress versus clinical depression, and concludes that special perinatal interventions may not be warranted.
42. Tammentie T, Tarkka M-T, Astedt-Kurki P, Paavilainen E. Sociodemographic factors of families related to postnatal depressive symptoms of mothers. International Journal of Nursing Practice, 2002; 8:240-246. Analysis of the EPDS items provides supportive evidence of the increasing presence of anxiety over depression.
43. Wenzel A, Haugen EN, Jackson LC, Robinson K. Prevalence of generalized anxiety at eight weeks postpartum. Arch Women Ment Health 2003; 6:43-49. This is an interesting discussion of postnatal anxiety, and its overlap with depression, and the specific things women worry about.
44. Glover V, O'Connor TG. Effects of antenatal stress and anxiety. Br J Psychiatry 2002; 180:389-391. A further discussion by this team of the effects of antenatal anxiety on the foetus, and how this could have longer-term effects on the child's development, with reference to the O'Connor et al. study [46].
45. Oates MR. Adverse effects of maternal antenatal anxiety on children: causal effect or developmental continuum? Br J Psychiatry 2002; 180:478-479. This is an interesting discussion of the interpretation of cut-off scores on continuous measures, and of the possible pathologizing of normal anxiety in pregnancy.
46. O'Connor TG, Heron J, Golding J, et al. Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. Br J Psychiatry 2002; 180:502-508.
47. Steiner M. Postnatal depression: a few simple questions. Fam Pract 2002; 19:469-470. Despite the methodological weakness of a lack of a comparison group, this is a useful example of how 'screening' does not need to be complicated.
48. Gross KH, Wells CS, Radigan-Garcia A, Dietz PM. Correlates of self-reports of being very depressed in the months after delivery: results from the Pregnancy Risk Assessment Monitoring System. Matern Child Health J 2002; 6:247-253. The authors present a very thorough sampling procedure of new mothers to examine variables correlated with feeling depressed since birth.
49. Beck CT. Recognizing and screening for postpartum depression in mothers of NICU infants. Adv Neonatal Care 2003; 3:37-46. The author stresses the point that evidence indicates that up to half of distressed mothers fail to be detected without a structured screening procedure. This paper also gives good clinical suggestions regarding the use of the author's two instruments (Postpartum Depression Screening Scale and Postpartum Depression Predictors Inventory).
50. Fergerson SS, Jamieson DJ, Lindsay M. Diagnosing postpartum depression: can we do better? Am J Obstet Gynecol 2002; 186:899-902. This useful study investigates the detection of maternal distress in an obstetrics outpatient department.
51. •], this provides more evidence that routine care fails to detect many distressed women postnatally. It also makes some pragmatic observations comparing the EPDS with the Postpartum Depression Screening Scale.
52. Lee DTS, Yip ASK, Chan SSM, et al. Postdelivery screening for postpartum depression. Psychosom Med 2003; 65:357-361. This study raised the important issue of when to screen for PND, and provided empirical evidence to back-up the discussion.
53. Tully L, Garcia J, Davidson L, Marchant S. Role of midwives in depression screening. British Journal of Midwifery 2002; 10:373-378. This is an interesting survey of how many maternity units systematically screen for depression. Also, their information shows that practically all units ask about psychological difficulties, yet it seems that this is not considered to be a 'screening' activity.
54. Shakespeare J. Health visitor screening for PND using the EPDS: a process study. Community Practitioner 2002; 75:381-384. This interesting paper describes the routine clinical use of the EPDS within the context of the National Screening Committee's recommendation that it not be used for PND screening. It provides information on why some practices choose not to screen.
55. Olson AL, Kemper KJ, Kelleher KJ, et al. Primary care paediatricians' roles and perceived responsibilities in the identification and management of maternal depression. Pediatrics 2002; 110:1169-1176. Within the debate of screening this provides some interesting information about some barriers to screening, including the perceived capability of these professionals.
56. •], this looks at some of the practical barriers to the use of screening in everyday practice.
57. National Screening Committee. Screening for postnatal depression. National electronic Library for Health [online resource]; 2001. http://www.nelh.nhs.uk/ screening/adult_pps/postnatal_depression.html. [Accessed 14 September 2001].
58. Shakespeare J. Evaluation of screening for postnatal depression against the NSC handbook criteria. National electronic Library for Screening [online resource] 2001. http://www.nelh.nhs.uk/screening/adult_pps/Shakespeare_ final_paper.pdf. [Accessed 10 August 2003].
59. McLennan JD, Offord DR. Should postpartum depression be targeted to improve child mental health? J Am Acad Child Adolesc Psychiatry 2002; 41:28-35. This complements the National Screening Committee (UK) in considering whether routine screening for PND meets various screening criteria.
60. Coyle B, Adams C. The EPDS: guidelines for its use as part of a maternal mood assessment. Community Practitioner 2002; 75:394-395. This paper demonstrates how the active voice of practitioners, who have found the EPDS to be extremely useful, has apparently swayed the National Screening Committee to relent somewhat on its initial stance that the EPDS, and screening for PND, should not take place.
61. Adams C. Ante and postnatal depression: where are we now and where should we be going? Community Practitioner 2002; 75:263-264.
62. Buist AE, Barnett BEW, Milgrom J, et al. To screen or not to screen: that is the question in perinatal depression. Med J Aust 2002; 177:S101-S105. This provides a counter-argument to the UK's National Screening Committees guidelines.
63. •].
64. Ross LE, Evans SEG, Sellers EM, Romach MK. Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Arch Women Ment Health 2003; 6:51-57. This good study explored the factor structure of the EPDS, highlighting the comparative endorsement of anxiety and depression items, and the need to develop an anxiety specific measure for the perinatal period.
65. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67:361-370.
66. Crawford JR, Henry JD, Crombie C, Taylor EP. Normative data for the HADS from a large non-clinical sample. Br J Clin Psychology 2001; 40:429-434.
67. Murray D, Cox JL. Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS). J Reprod Infant Psychol 1990; 8:99-107.
68. Evins GG, Theofrastous JP, Galvin SL. Postpartum depression: a comparison of screening and routine clinical evaluation. Am J Obstet Gynecol 2000; 182:1080-1082.
69. Hearn G, Iliff A, Jones I, et al. Postnatal depression in the community. Br J Gen Pract 1998; 48:1064-1066.
70. Priest S, Henderson J, Evans SF, Hagan R. Stress debriefing after childbirth: a randomised controlled trial. Med J Aust 2003; 178:542-545. This well-structured study drew the distinction between unstructured debriefing following birth that has been tried, and the more structured critical incident stress debriefing. It raised the possibility that one-off debriefing sessions may be insufficient for women who have a negative birth experience.
71. Reid M, Glazener C, Murray GD, Taylor GS. A two-centred pragmatic randomised controlled trial of two interventions of postnatal support. BJOG 2002; 109:1164-1170. One of the interesting discussion points from this study is the low attendance rate of women into the support group intervention. As with multi-session antenatal interventions, we need to consider whether people will actually attend interventions thought to be helpful.
72. Heh S-S, Fu Y-Y. Effectiveness of informational support in reducing the severity of postnatal depression in Taiwan. J Adv Nurs 2003; 42:30-36. Although the benefits of the PND information booklet may have been due to the Hawthorne effect, the issues raised about the cultural aspects of this study are interesting.
73. MacArthur C, Winter HR, Bick DE, et al. Effects of redesigned community postnatal care on women's health 4 months after birth: a cluster randomised controlled trial. Lancet 2002; 359:378-385. This interesting and well-designed study added to the debate over the benefits of continuity of care.
74. Marks MN, Siddle K, Warwick C. Can we prevent postnatal depression? A randomized controlled trial to assess the effect of continuity of midwifery care on rates of postnatal depression in high-risk women. J Matern Fetal Neonatal Med 2003; 13:119-127. This intervention provides a contrast with other continuity of midwifery care studies in that it did not provide specialist counselling training. It also provides a good overview of the fact that many women do not attend traditional psychosocial services, and therefore there is a need to provide services which will be accessed.
75. Koniak-Griffin D, Verzemnieks IL, Anderson NLR, et al. Nurse visitation for adolescent mothers: two-year infant health and maternal outcomes. Nurs Res 2003; 52:127-136.
76. Koniak-Griffin D, Anderson NLR, Brecht M-L, et al. Public health nursing care for adolescent mothers: impact on infant health and selected maternal outcomes at 1 year postbirth. J Adolesc Health 2002; 30:44-54. This paper is an interesting example of where the careful reader may disagree with the conclusions of the authors.
77. Cooper PJ, Landman M, Tomlinson M, et al. Impact of a mother-infant intervention in an indigent peri-urban South African context. Br J Psychiatry 2002; 180:76-81. This raises the possibility that interactional style can be modified despite ongoing environmental stresses that contribute to depressed mood.
78. Chabrol H, Teissedre F, Saint-Jean M, et al. Prevention and treatment of post-partum depression: a controlled randomized study on women at risk. Psychol Med 2002; 32:1039-1047. This excellent study combined prevention and treatment in a clinically viable manner. It took into account the low attendance rate of women offered services for PND, and, thus, in particular tailored the prevention arm to ensure maximum uptake.
79. Llorente AM, Jensen CL, Voigt RG, et al. Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Am J Obstet Gynecol 2003; 188:1348-1353.
80. Harris B, Oretti R, Lazarus J, et al. Randomised trial of thyroxine to prevent postnatal depression in thyroid-antibody-positive women. Br J Psychiatry 2002; 180:327-330. This is a well designed double blind randomized controlled trial showing no beneficial prophylactic effects of thyroxine at five assessment points up to 6 months postpartum.
81. Hughes P, Turton P, Hopper E, Evans CDH. Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study. Lancet 2002; 360:114-118. The results from this study, that holding their baby after a stillbirth may not in fact be psychologically helpful, indicates that it is simplistic to think there is one 'best' practice for all women to prevent distress.
82. Spinelli ME, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry 2003; 160:555-562. This provides an example of interpersonal psychotherapy for depressed women in pregnancy, which builds on the work of this type of therapy for postnatally depressed women.
83. Oren DA, Wisner KL, Spinelli M, et al. An open trial of morning light therapy for treatment of antepartum depression. Am J Psychiatry 2002; 159:666-669. While the authors acknowledge that a randomized controlled trial is needed to rule out placebo effects for this treatment, it is a good example of a single-case design methodology.
84. Dennis CL. The effect of peer support on postpartum depression: a pilot randomized controlled trial. Can J Psychiatry 2003; 48:115-124. This innovative study using trained volunteers overcame the hurdle of drop-outs in treatment by using an intervention delivered by phone.
85. Honey KL, Bennett P, Morgan M. A brief psycho-educational group intervention for postnatal depression. Br J Clin Psychology 2002; 41:405-409. This study, while showing improvements in the women's moods, raised the interesting question of why some outcome measures (e.g. ways of coping) that are a focus of the intervention do not change.
86. Fogarty B, Kingswell S. Pals in pregnancy: a luxury or a lifeline? British Journal of Midwifery 2002; 10:554-559. This is an interesting discussion of some of the practical difficulties in trying to implement this type of clinical service, and a realistic understanding that such a service may be of benefit to only a sub-sample of women.
87. Cooper PJ, Murray L, Wilson A, Romaniuk H. Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression. 1. Impact on maternal mood. Br J Psychiatry 2003; 182:412-419. This was a well designed intervention study. Apart from the main findings, interesting issues are session attendance and compliance/attrition classification; the provision of different treatment types by the same therapist; and what constitutes cognitive behavioural therapy.
88. ••]. There is an interesting discussion on the effects of therapies on the mother-infant relationship.
89. Hiscock H, Wake M. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ 2002; 324:1062-1065. This well designed study showed that for some women intervening with effective strategies to reduce unsettled infant behaviour will have significant benefits on the maternal mood. It also makes an interesting comparison on benefits gained as compared with a more intensive psychological treatment for PND.
90. Holden JM, Sagovsky R, Cox JL. Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression. BMJ 1939; 293:223-226.
91. Beutler LE, Engle D, Mohr D, et al. Prediction of differential response to cognitive, experiential, and self-directed psychotherapeutic procedures. J Consult Clin Psychol 1991; 59:333-340.
92. Beck CT. Theoretical perspectives of postpartum depression and their treatment implications. MCN Am J Matern Child Nurs 2002; 27:282-287. This author discusses a variety of theoretical models and their treatment implications for PND (except cognitive or behavioural models).
93. Ugarizza DN. Postpartum depressed women's explanation of depression. J Nurs Scholarsh 2002; 34:227-233. This discusses how the symptoms experienced by women with PND do not correspond to those required in DSM-IV.
94. Beck CT. Postpartum depression: a metasynthesis. Qual Health Res 2002; 12:453-472.
95. Alder E, Truman J. Counselling for postnatal depression in the voluntary sector. Psychol Psychother 2002; 75:207-220. This presents an interesting view regarding the appropriate research design when investigating the effectiveness of treatments for this population.
96. Brocklehurst P. Partially randomized patient preference trials. BJOG 1997; 104:1332-1335.