3 Questions Can Spot Possible Postpartum Depression
TUESDAY Sept. 2, 2008 -- Three simple questions were just as good as conventional screening for identifying potential postpartum depression among new mothers.
"Postpartum depression is under-diagnosed," said Dr. Adam Aponte, a pediatrician and associate director for recruitment and retention at Mount Sinai School of Medicine in New York City. "We found the fewer the questions, the better. It opens the door for dialogue about how the mom is doing. The last thing you want is a depressed mom. It's important to screen."
Aponte was not involved in this study, which is in the September issue of Pediatrics.
According to background information in the study, postpartum depression is the most common problem new mothers confront. The condition is characterized by high levels of anxiety, but screening is not routinely performed due to time and other constraints.
The researchers run the Colorado Adolescent Maternity Program (CAMP) for young mothers and their children in Denver. The center, which has both pre-birth and post-birth services, provided a unique opportunity to follow up with new mothers. The lead author of the study, Dr. Catherine Stevens-Simon, founded CAMP and directed it from 1991 to 2006; she passed away in November 2007.
For the study, 199 14- to 26-year-old mothers filled out the standard Edinburgh Postpartum Depression Scale at well-child visits during the first six months after the birth of their child.
The women then filled out three shorter versions of that scale.
A three-item anxiety sub-scale of the Edinburgh Postpartum Depression Scale turned out to be a better screening tool than the two other abbreviated versions which are almost the same as the commonly used Patient Health Questionnaire.
For this sub-scale, new mothers were asked to answer "Yes, most of the time," "Yes, some of the time," "Not very often" or "No, never" to the following statements:
- I have blamed myself unnecessarily when things went wrong.
- I have felt scared or panicky for not very good reason.
- I have been anxious or worried for not very good reason.
"We chose these three questions, because other studies have suggested that postpartum depression has a large anxiety component, and those three questions are related specifically to anxiety," said study co-author Jeanelle Sheeder, a senior instructor in pediatrics at the University of Colorado in Denver. "That subscale would probably be reasonable in other populations as well, because a lot of postpartum depression in general is related to that feeling of not knowing what to do and being scared or panicky."
The subscale identified 16 percent more mothers as depressed than the original, longer questionnaire.
"The beauty of three questions is it helps us hone in on what the patient is going through, so we can investigate further," Aponte said.
Posted: September 2008