The Edinburgh Postpartum Depression Scale (EPDS), is an assessment tool commonly used to detect symptoms of depression in mothers after giving birth to a baby. The scale is typically administered during postpartum check-ups. Evidence suggests that the EPDS is also able to detect symptoms of anxiety and suicidality. However, few other screening tools are available to screen mothers, specifically during pregnancy when women may present physicial and emotional symtpoms.
Nearly half of all pregnant women experience some degree of mental health symptoms. It is estimated that up to 15% of mothers eperience new onset depression, up to 16% experience anxiety, up to 10% experience suicidal ideation, up to 2% experience post-traumatic stress disorder (PTSD), and up to 50% of women with eating disorders relapse. Despite the prevalence, the bulk of mental health screening occurs in postpartum and focuses on depression, failing to detect other symptoms throughout each stage of pregnancy and birth.
It is estiamted that pregnant women have significantly lower rates of mental health diagnosis and treatment than the general population.
Screening for mental health during pregnancy may not be a widespread practice due to lack of resources and training. It is possible that if we screen during the period of pregnancy, there may not be steps in place to follow up with resources or provide adequate support. Additionally, limited research exists on the impact of prenatal mental illness on the outcomes of both mother and baby. A lack of understanding may lead to less proactive screenings and preventative care.
Limited research exists on the impact of prenatal mental illness on birth outcomes, although several studies ahve examined the impact of serious mental illnes (SMI). For example, bipolar disorder and major depressive disorder, both SMIs, are associated with a higher likelhood of preterm birth, congenital malformations, neonatal morbidity, neonatal hospital readmissions, and having a small or large for gestational age (SGA or LGA) neonate. Pregnant women with schizophrenia are more likely to experience preeclampsia, a pregnancy complication characterized by persistent high blood pressure which can affect the nutrient and oxygen flow to the baby. Depression during pregnancy has been linked to preterm birth and anorexia nervosa has been associated with low birthweight.
We also know that postpartum maternal depression and anxiety can lead to impaired mother-child interaction including attachment and breastfeeding rates. Postpartum mental illness may also increase risk for mental illness in the child, including anxiety and impulsivity.
Dr. Aparna Kumar, CRNP, seeks to improve screening, detection, and treatment of a broader spectrum of symptoms and to ultimately improve outcomes for women with psychiatric symptoms, specifically during the prenatal period. Her research provides that the EPDS can be used during the prenatal period to detect symptoms beyond depression.
Ultimately, she seeks to provide evidence for a new model for screening in the prenatal period in addition to the postpartum perid. Determining this model has the potential to increase identification of women with prenatal mental health symptoms, provide and accessible resrouce for obstetric care providers, and to improve standard of care for screening and treatment of psychiatric disorders in the prenatal period. It may also help identify additional behavioral trats of women who may be at high risk for mental health conditions in pregnancy.
The EPDS score should not override a professional clinical opinion. Support from a mental health care provider as well as peer-support from friends and family can make a difference. Find inpatient and outpatient services provided by Jefferson University hospitals.
The information provided here was adapted from Dr. Aparna Kumar and Dr. Angela Gerolamo's proposal for the Stratton Foundation Pilot Grants.
Allbaugh, L., Marcus, S., Ford, E., & Flynn, H. (2015). Development of a screening and recruitment registry to facilitate perinatal depression research in obstetric settings in the USA. International Journal of Gynecology and Obstetrics, 3(1), 260-263.
Rubin, L. & Maki, P. (2015). Heterogeneity of postpartum depression: a latent class analysis. The Lancet Psychiatry, 2(1), 59-67.
Iliadis, S., Skalkidou, A., Ranstrand, H., Georgakis, M., Axfors, C., & Papadopoulos, F. (2018). Self-harm thoughts postpartum as a marker for long-term morbidity. Frontiers in Public Health, 6(34). DOI: 10.3380/p8bh.2018.0034.
Horowitz, J.A., Murphy, C., Gregory, K., & Wojcik, J. (2009). Best practices: community-based postpartum depression screening: Results from the CARE study. Psychiatr Serv., 60(11), 1432-1434.
Glasheen, C., Colpe, L., Hoffman, V., & Warren, L. (2015). Prevalence of Serious Psychological Distress and Mental Health Treatment in a National Sample of Pregnant and Postpartum Women. Maternal and Child Health Journal, 19(1), 204-216. Retrieved from: https://doi.org/10.1007/s10995-014-1511-2
Schetter, C. Anxiety, depression, and stress in pregnancy: implications for mothers, children, research, and practice. Curr. Opin Psychiatry, 25(2), 141-148.
Austin, M., Priest, S., & Sullivan, E. (2008). Antenatal psychosocial assessment for reducing perinatal mental health morbidity. Cochrane Database of Systematic Reviews, Issue 4, Art. No.: CD005124. DOI: 10.1002/14651858.CD005124.pub2.
Dennis, C., Falah-Hassani, K., Shiri, R. (2018). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. British Journal of Psychiatry, 210(5), 315- 323.
Orsolini, L., Valchera, A., Vecchiotti, R., Tomasetti, C., Iasevoli, F., Fornaro, M., DeBerdaris, D., Perna, G., Pompii, M., & Bellantuono, C. (2016). Suicide during the perinatal period: Epidemiology, risk factors, and clinical correlates. Frontiers in Psychiatry, 7: 138. DOI: 10.3389/fpsyt.2016.00138.
Howard, L., Molyneaux, E., Dennis, C., Rochat, T., Stein, A., & Milgram, J. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384(9956), 1775- 1788. Retrieved from: https://doi.org/10.1016/S0140-6736(14)61276-9
The American College of Obstetricians and Gynecologists (ACOG). (2018, November). ACOG Committee Opinion #757: Perinatal Depression. Obstetrics and Gynecology, 132(5). Retrieved from: https://www.acog.org/-/media/Committee-Opinions/Committee- on-Obstetric-Practice/co757.pdf?dmc=1&ts=20181126T2015054111
Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behav Dev, 33(1). DOI: 10.1016/j.infbeh.2009.10.005. Hoffman, C., Dunn, D., & Njoroge, W. (2017). Impact of postpartum mental illness upon infant development. Current Psychiatry Reports, 19(100). Retrieved from: https://doi.org/10.1007/s11920-017-0857-8
Field, T. (2018). Postnatal anxiety prevalence, predictors and effects on development: A narrative review. Infant Behavior and Development, 51, 24-32.
Goodman, J., Watson, G., & Stubbs, B.(2016). Anxiety disorders in postpartum women: A systematic review and meta-analysis. Journal of Affective Disorders, 292-331.
Iliadis, S., Skalkidou, A., Ranstrand, H., Georgakis, M., Axfors, C., & Papadopoulos, F. (2018). Self-harm thoughts postpartum as a marker for long-term morbidity. Frontiers in Public Health, 6(34). DOI: 10.3380/p8bh.2018.0034.
Boden, R., Lundgren, M., Brandt, L., Reutfors, J., Andersen, M., & Kieler, H. (2012). Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilizers for bipolar disorder: population based cohort study. BMJ, 345, e7085. DOI: 10.1136/bmj.e7085
Stein, A. et al. (2014). Effects of perinatal disorders on the fetus and child. The Lancet, 384(9986), 1800-1819. DOI: 10.1016/S0140-6736(14)61277-0
Mei-Dan, E., Ray, J., Vigod, S. (2014). Perinatal outcomes among women with bipolar disorder: A population-based cohort study. Am J Obstet Gynecol, 212(3), 361.e1-367.e8. Retrieved from: https://doi.org/10.1016/j.ajog.2014.10.020
Lin, H., Chen, I., Chen, Y., Lee, H., & Wu, F. (2010). Maternal schizophrenia and pregnancy outcome: Does the use of antipsychotics make a difference? Schizophrenia Research, 116, 55-60.
Grote N., Bridge J., Gavin A., Melville J., Iyengar, S., Katon, W. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry, 67, 1012–24.
Ding, X. et al. (2014). Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord, 159C, 103–10.
Micali N, Treasure J. Biological effects of a maternal ED on pregnancy and fetal development: a review. (2009). Eur Eat Disord Rev, 17, 448–54.