By Dr. Dawn Kingston
While postpartum depression is often the focus of the medical community and the public alike, the fact is that up to 80% of women who struggle with postpartum depression had symptoms that could have been detected first in pregnancy. Early detection and treatment could save months of hardship to women and their families.
Here are several frustrations that some clinicians raised to me, including:
- Confusion over screening tools used to detect anxiety or depression in pregnant women;
- How to help women who need and want help;
- Frustration with inadequate services in the community and the intolerable wait time to get women into very limited service offerings.
This is not the first time I’ve heard these sentiments. This is the situation in North America for many primary care providers.
Let me provide some guidance surrounding these issues.
Detecting Anxiety and Depression in Pregnancy
Question: What screening tools should be used to detect anxiety or depression in pregnant women?
A major challenge in primary care is, as we all know, lack of time. Our research shows that the majority of women don’t talk to their doctors about emotional health issues because there just isn’t enough time, and they’re not sure whether what they are experiencing is just a part of “normal” pregnancy. Women have told us they want to be “good patients,” and so they don’t bring up concerns about anxiety, stress or depression they have.
However, 97% of women also told us in a provincial survey that if their provider asked them first about emotional health, they would be pleased to respond and could be honest with them.
The NICE guidelines that were published in December 2014 presented (in my view) the best solution. They recommended two validated, but very brief, questionnaires that could be asked in any primary care setting in under 5 minutes. Remember: these are not DIAGNOSTIC tools. They are screening questions that can efficiently identify women that are struggling and require a more in-depth follow-up.
For depression, they recommended the 2-question Patient Health Questionnaire (PHQ-2):
Over the past 2 weeks, how often have you been bothered by any of the following problems:
- Little interest or pleasure in doing things
- Feeling down, depressed or hopeless
For each question, answer: 0=Not at all; 1=several days; 2=more than half the days; 3=nearly every day
Notes: The score ranges from 0-6. If a woman scores 3 or more based on adding her score to question 1 and question 2, she should receive a follow-up appointment with a clinician who can conduct a more thorough assessment of her needs or be referred to a cognitive behaviour therapy program.