Whether it is antenatal (prenatal) or postpartum (postnatal) depression, the sooner perinatal depression is identified the better. A good and reliable depression screening program is key to protecting women’s mental health.
Let’s look at what’s available worldwide for screening women during pregnancy and/or the postpartum period.
Perinatal depression test statistics
Western societies are really failing women. Whether it is the American Psychiatric Association or PANDA association in Australia or the World Health Organization, they all agree and are genuinely worried about perinatal depression. There’s a good reason for it. For a large proportion of women, their mental health is severely affected after they fall pregnant. We’re talking about healthy women who decide to have a baby and suffer a deeply invalidating mental health condition. This largely results from an obsolete obstetric health care approach that does not only fail to meet a woman’s needs but also makes her ill.
Research hasn’t shone much light on either postpartum depression or antepartum depression, because studies aren’t based on the key element.
Sadly, what society demands from women, from their early childhood, is incompatible with giving birth and remaining mentally stable, given the resources most women have.
Most women struggle to keep up with societal expectations because, well… they’re endless. It’s a vicious circle – and that’s the problem. Societal expectations have been imposed on us for many generations and we will pass them on to our daughters, unless we break the cycle.
When it comes to motherhood, in many individual cases, women’s needs aren’t met. When a woman becomes a mother, keeping up with expectations as well as parenting a new baby often seems impossible and she breaks. If it happens earlier (before the birth) we call it prenatal depression; if later, it’s called postpartum depression.
Statistics on perinatal depression are so scary that providers must provide good, thorough and reliable perinatal depression screening to their clients.
You should welcome a direct approach from your provider, especially when you are offered depression screening. Some women feel embarrassed or doubtful when asked about their mental health condition. Remember, screening is exactly that: testing everyone so most people with a potential mental illness can be spotted and offered further evaluation with a more individual approach.
The Edinburgh Postnatal Depression Scale (EPDS)
The Edinburgh Postnatal Depression Scale (EPDS) is a postpartum depression screening tool focused on identifying symptoms of postpartum depression.
This is a questionnaire about how pregnancy or childbirth has affected a woman’s mental health. It looks at her support network and her ability to cope with her new baby and her new life.
You might have heard about the ‘baby blues’, where a woman might have felt sad and overwhelmed with the arrival of the baby. The baby blues can certainly be a difficult time of adaptation to the new life after childbirth. Postpartum depression, on the other hand, is a severe mental disorder.
The EPDS is a 10-item questionnaire with multiple choice answers; it focuses mainly on the woman’s life in the past few days or weeks.
Read more about this in Edinburgh Postnatal Depression Scale – Take The Test.
Perinatal depression screening
The EPDS was first developed as a postpartum depression test; however, depending on whether the onset happens during pregnancy or after the birth of the baby, there are modified versions of this postpartum depression screening tool.
Many of the symptoms are common to all types of perinatal depression regardless of the time of its onset. Some symptoms women experience are: having difficulty sleeping, feeling anxious about the birth or about being with the baby on their own or feeling sad and having little joy.
Many women find it difficult to see the beauty in life and, in many cases, are unable to explain why, because, apart from the baby’s arrival, ‘nothing has changed’.
Childbirth, however, is extremely transformative. Women shouldn’t be expected to ‘keep up’ at any level apart from looking after their new baby; the rest of the family should try to care for both their needs.
Perinatal depression screening should be offered to all women antenatally.
Research shows that, in Australia, 80% of women are screened during pregnancy and also postnatally. I haven’t been able to find anything specific about antenatal mental health screening in the UK’s NHS pages. In the US, it differs from one provider to another but antenatal depression screening is not common. Of course, the moment a woman tells her provider she’s worried about her mental health the right pathways will be followed, and diagnosis, support, coping strategies and treatment will be provided.
However, without active screening for depression during pregnancy, many women will be missed and their depression will develop further until the symptoms, as well as the devastating consequences, are more obvious.
What is a positive Edinburgh Postnatal Depression Scale?
This test has answers with different values, which are added up and matched to the scale.
For mild depression, the scale runs from 7 to 13; for moderate depression, 14 to 19; cases with scores of 20 to 30 would be classified as severe depression.
Anything above 13 (or 11 in more conservative cases) should be investigated further, as the risk of perinatal depression is high.
Is the Edinburgh Postnatal Depression Scale reliable?
This is as good as it gets in terms of reliability. A postpartum depression test (like most tests) means little, however, without the skills of a trained healthcare provider.
To date, EPDS has helped with thousands of perinatal depression diagnoses. There is still a stigma attached to perinatal depression and women tend to hide their symptoms. It’s as though they feel responsible for their mental status; as if it’s their fault or they’ve failed when, in fact, society has failed them.
The test is reliable because it alerts your healthcare provider to look deeper into the signs of a very debilitating illness in its early stages when its harmful impact can be minimized.
When should EPDS testing be done?
As soon as there is an unhappy pregnant woman or new mother who finds herself crying too frequently for no apparent reason, it’s the right time to look for help, as those are the very early indications. If it’s just a mood swing or fatigue and it turns out there’s nothing to worry about, you will feel relieved and reassured that you’ve done the right thing by telling your midwife or doctor about your worries. It’s always better to be safe than sorry. It’s even more important when early diagnosis and therapy can substantially help the healing process.
The importance of looking after your own mental health
Caring for oneself is one of the most fulfilling achievements a person can experience. Being able to ask for help when you need it is, ultimately, the most loving care you can provide yourself.
You don’t have to prove anything to anyone and you should know it’s not your fault. There is treatment, therapy and support groups, and great medicine to help you get back on track . One of the biggest risk factors for depression turning into a severely incapacitating illness is the inability, or unwillingness, to ask for help.
If you’re struggling with your mental health, here are some contacts for helplines. Use them even if you’re not sure and just need to talk to someone.
Contact the service in your country:
Uunited Kingdom;
Australia;
USA;
Canada.
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