Postpartum Depression
Younglee KIM, RN, PHN, MSN
Today class objectives

To understand importance
of PPD care

To verbalize correct
symptoms of PPD

To understand how to use
the EPDS screening tool
2
Introduction

Over the centuries, normal thought is that the moment
when a pregnant woman delivers her child that it will
be a special and precious moment for her, but studies
show that is not always so.

Unfortunately, all of women have not felt joy and
feeling of pleasure normally associated with bring a
new life into this world.

Many of women have reported
depressed mood, fatigue, and
feeling of worthless or excessive.
 Family members easily ignore
mothers’ feelings of unhappiness
and sandiness during postpartum
period
 Medical attention has tended to
ignore the seriousness of PPD,
too.
The broad meaning of depression
 Depression
is probably the most common
psychiatric complaint, and it was called
melancholia.
 The course of the disorder is extremely
variable from persons to persons.
 It may be mild or severe, acute or chronic.
 In psycho logy, it is about feelings of low self
– worth or guilt and a reduced ability to enjoy
life.

Hormonal change decrease the levels of
progesterone and estrogen after placental
delivery cause a change in the neurotransmitter levels in
leading to symptoms of depression (Cohen & Nonacs,
2005)

Three terms of depression during the postpartum period;
postpartum blues (the baby blues),
postpartum depression (PPD), and
postpartum psychosis.
Postpartum blues
(baby blues)
Incidence
Onset
Duration
Symptoms
50% -80%
Day 2-5
Few days
Changed mood
Episodic tearfulness
Irritability, Anxiety
Overwhelming
Lost appetite
Sleeping problem
Postpartum depression (PPD)
Incidence
Onset
Duration
5-15%
the first 2 weeks-3 months
Up to 1 year
Symptoms
Depressed mood,
Sleep changes
Anxiety
Fatigue
Feeling worthless
Inability to concentrate
Suicide plan or attempt
Postpartum psychosis
Incidence
Onset
Duration
Symptoms
0.1%
the first 2 weeks-6 weeks
Weeks to months
Irritability
Confusion
Psychotic symptoms
Delusion
Hallucination
The symptoms of PPD
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Depressed mood.
Loss of interest or pleasure in activities of life.
Sleep changes.
Agitation or retardation in movements.
Fatigue or loss of energy.
Feeling worthless or excessive inappropriate guilt.
Inability to concentrate or think; being indecisive every day.
Thought of death, suicidal ideation without a plan or a suicide
plan or attempt.
Somatic symptoms, including headache, constipation,
diarrhea and severe anxiety.
Shame and low self-esteem.
the American Psychiatric Association (APA)
The significant predicators of
PPD
1.
2.
3.
4.
5.
6.
7.
8.
History of prenatal anxiety
Occurrence of postpartum blues
Low self-esteem
A stressful life resulting in excessive demands
Lack of social support from family and friends
A strained material relationship
The nature of the infant’s temperament
Childcare stress
(Lintner & Gray, 2006)
Screening tools

Center of Epidemiological Studies-Depression
Scale (CES-D)
 Edinburgh Postnatal Depression Scale (EPDS)
 Postpartum Depression Screening Scale (PDSS)
 Beck Depression Inventory Second Edition (BDIII)

The CES-D ---The scale consists 20 items, with four responses
ranging from “rarely” to “most of the time”, and measure
depressive symptoms occurring during the past week

The PDSS --- It consists 35 items and assesses for dimensions
of depression related to sleeping/ eating disturbances, anxiety/
insecurity, emotional liability, loss of self, guilty/ shame,
cognitive impairment, contemplating harming oneself and
thoughts of suicide.

The BDI-II--- It includes a 21 –items, multiple-choice screening
tool that assesses for the presence of depression, as well as the
severity of depression, and corresponds well with DSM-IV-TR.
The EPDS



A commonly recommended screening tool of PPD.
The question based on mother’s feelings over the past 7 days
10 items to detect prenatal and postnatal depression.
 The English and Spanish versions
 The total score is ranged from 0 to 30.
 The bigger score means a more severely depressed
 Possible Depression: 10 or greater
 Severe condition: 13 or greater
 Always look at item 10 (suicidal thoughts)
The practice
Thank you!