Perinatal mood and anxiety: Assessment
Assessing "postpartum blues"
Between 50 and 85 per cent of women experience "postpartum blues". Key features include:
- transient, mild symptoms
- no loss of functionality
- self-limited to two weeks
No major intervention is required for postpartum blues.
Assessing depressive disorders
- Use the Edinburgh Postnatal Depression Scale, a validated self-rated tool
- Screen at 28–32 weeks of gestation and again six to eight weeks postpartum.
- Frequently screen women from high-risk populations.
- Review symptoms of depressive disorders outlined in the DSM.
- Take a personal psychiatric history and family psychiatric history.
- Assess premenstrual-, contraceptive- and seasonal-related mood changes.
- Assess suicidality.
- Exclude medical morbidity (e.g., anemia, thyroid, renal, hepatic disease).
- Assess substance use.
- Assess supports, including partner, family and social supports.
- Ask about bonding with the child, both during pregnancy and after.
- Observe maternal-infant interaction.
Assessing postpartum psychosis
- Rare occurrence (1–2 /1,000)
- Rapid development of delusions and hallucinations, labile mood and behaviour, and agitation in the first few weeks after delivery
- Psychiatric emergency that requires hospitalization
- Suicidal and homicidal potential
- Often the first presentation of bipolar disorder
Assessing anxiety disorders
All pre-existing anxiety disorders may worsen in the perinatal period.
- This is the most common anxiety disorder presentation.
- Look for unusual or unrelated somatic complaints.
- Ask about ER and walk-in clinic visits.
Generalized anxiety disorder
- This diagnosis is commonly missed.
- Look for excessive worry ("What if …?"), constantly seeking reassurance, catastrophizing events.
Obsessive-compulsive disorder (OCD)
- This frightening condition often involves horrific intrusive thoughts of harming the baby or oneself.
- Reassure the patient, since the risk of acting on these thoughts is extremely small.
- Look for worsening of pre-existing OCD.
Best practice guidelines for mental health disorders in the perinatal period (BC reproductive mental health program, 2014)
(NICE guideline CG192, 2014)