Prevention of Postnatal Depression: A Health promotion issue
Introduction:
It is well documented that 10-15% of women experience postnatal depression (PND) in
the first year following childbirth (Cooper et al, 1988, O’Hara et al, 1989). The severity
of the illness varies greatly and the effects of the illness can cause problems throughout
the family unit (Lovestone and Kumar, 1993).
Where symptoms are not detected or go untreated, a woman’s mental health can be
severely affected, as can the marital / partner relationship. Fifty per cent of spouses suffer
concurrent mental illness, usually depression (Forman et al, 1992; Lovestone and Kumar,
1993).
By definition postnatal depression impairs the mother in her daily life. Often this means
that her relationship with her baby will be affected. A profile of mother-infant
disturbance in the context of postnatal depression has emerged, with affected parenting
manifested in either a withdrawn, disengaged parenting style or an intrusive, hostile one.
The importance of detecting and responding to these cases is underlined by the growing
knowledge of adverse effects on the psychological, cognitive and intellectual
development of the children (Murray and Cooper, 1997, Sharp et al.1995 and Hay et
al.2001.)
In the ‘Why Mothers Die’ report of 1997-1999 suicide accounts for 10% of maternal
deaths, and the report suggests that, if a large number of unreported deaths from
psychiatric causes were taken into account, it would be the leading cause of maternal
mortality (Royal College of Obst. and Gynaec.).
Screening and prediction of Postnatal Depression:
Research conducted in the Rotunda Hospital in Dublin in 2,000 found that 13.4% of
women suffered from PND by six weeks post partum. The research found that women
who subsequently developed PND could be identified prior to discharge from hospital by
eliciting a history of depression, combined with a positive score on the Edinburgh
Postnatal Depression Scale (EPDS) (Crotty F.,Sheehan J.). The EPDS is a self-report tenitem scale designed by Cox et all (1987). It is validated and reliable and is used
internationally. It has a sensitivity of 86% and a specificity of 78% at a cut-off of equal to
or above 12.
In order to increase awareness of Postnatal Depression, routine screening using the EPDS
is offered to delivered mothers prior to discharge from the Rotunda Hospital. Following
completion of the EPDS women with a positive score are given the chance to discuss
their feelings and plan appropriate support from family, friends and professionals in the
community or the hospital as appropriate. An information booklet is also given to all
mothers, with advice to read it with their partners so they can then plan preventive
strategies together.
Advantages of screening in Maternity Hospital
The psychological care of postnatal women is currently haphazard in the Irish Healthcare
setting. For their six-week postnatal check-up women may attend the Maternity Hospital,
Consultant Obstretrician, GP or may not attend anyplace. The EPDS is acceptable to both
mothers and staff with over eighty percent of women returning the completed
questionnaire in the Rotunda Hospital. In a study by Murray and Carothers (1990) over
ninety seven percent returned the questionnaire.
Mauthner (1997) found that the greatest difficulty the mothers faced was admitting their
feelings and difficulties. The EPDS is the ideal tool to help open the subject.
Encouragement to talk about their feelings in the early postnatal period may help prevent
later emotional problems from developing. Helping women to recognise their own needs,
and to believe that those are valid, can empower them to seek help.
Low mood is often seen as added workload or tiredness by mothers rather than
depression (Small, 1994). Women who do realise they need help may be unable to
organise themselves to make an appointment. Most women with PND do not require
psychiatric intervention. The reassurance of a supportive professional may be sufficient
(Holden J.,1991). Holden also states that a high percentage of women commented that it
had been a relief to be asked about their feelings.
Completing the questionnaire only takes minutes. The decision to reveal their feelings to
a Health Professional is one that any individual must be free to make for themselves.
They must be reassured that it is safe to do so and that help is available without her
having to ask for it.
Some mothers may be afraid if they confide the extent of their distress they may be
labeled mentally ill or fear that the baby may be taken into care. These concerns are
addressed at the time of screening and a follow-up supportive service offered to women
who wish to avail of it.
Conclusion
Respecting women’s individual needs and responses, involving them in their own care,
creating a climate in which they, their partners and their caregivers feel free to discuss the
emotional and practical implications of parenthood are important steps towards
promoting the psychological wellbeing of childbearing women and the future generation.
(Holden,1991)
Clearly, the emotional disturbance associated with postnatal depression underlines the
need for prompt and cost-effective management. The Rotunda Hospital initiative is
increasing awareness and detection of PND and consequently preventing many serious
adverse outcomes.
References
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