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Contribution Paper
Contribution Paper
Abstract
Peripartum depression is a mental health concern affecting a number
of new or expecting mothers today. More so, those mothers
experiencing peripartum depression are at an increased risk for
suicidal ideation. To protect the health and safety of mothers and their
families, it is necessary that health workers screen for these
occurrences routinely. The Edinburgh Postnatal Depression Scale is a
commonly used screening tool for postnatal depression that is also
relevant and valid for screening for suicidal ideation. This paper will
further explain its use and relevance.
very common syndrome, first occurs within the first few days after
delivery (St. Pierre, 2007). However, unlike with the syndromes further
down the continuum, the baby blues stop within about ten days to two
weeks after delivery and do not require treatment (St. Pierre, 2007;
Cohen et al., 2010). A mother experiencing the baby blues is often sad
and has crying episodes, is irritable and/or anxious, and does not sleep
well (Cohen et al., 2010). These mothers do not experience suicidal
ideation, however, which is an important distinction from the other
types of depression along the continuum.
Perinatal psychosis is a very serious condition and a cause for
immediate treatment. The onset is sudden and happens within two
weeks of delivery. Symptoms include sleep disturbances, mood lability,
and obsessions about the newborn (Bergink et al., 2015). As it
continues, more severe symptoms become present. The mother may
have hallucinations, delusions, and disorganized speech or behavior
(Cohen et al., 2010; Bergink et al. 2015). Much of the concern
surrounding peripartum psychosis comes from the high risk of suicide
and infanticide (Cohen et al., 2010).
Suicide accounts for a significant number of deaths in pregnant
and postpartum women. Suicidal ideation, planning, and/or attempts
are also related to depression. Gavin et al. (2011) reported that 52.5%
of women who reported suicidal ideation also had comorbid perinatal
depression. Of those who did report suicidal ideation, 78% reported
having thoughts of suicide several days in the last two weeks, 15.3%
reported having those thoughts more than half the days, and 2.7%
reported suicidal ideation nearly everyday (Gavin et al., 2011). With
such significant numbers of women reporting suicidal ideation during
the perinatal period, it is incredibly important that clinicians screen for
perinatal depression and suicidal ideation. Nevertheless, most women
who are receiving perinatal health care are not being screened (Kelly et
al., 2001).
Cox, Holden, and Sagovsky (1987) developed a tool to screen for
perinatal depression, the Edinburgh Postnatal Depression Scale. The
researchers noted several limitations in other commonly used
screening measures when applied to new or expecting mothers.
Namely, they believed that the poor validity of these tools with this
population was due to the fact that the tools relied heavily on somatic
symptoms. They believed that many of the somatic symptoms
described in a psychiatric disorder might simply be the result of natural
pregnancy, for example, fatigue and loss of energy (Cox, Holden, &
Sagovsky, 1987). The final result is a ten-question screen. The
questions are on a four point Likert scale between 0 and 3. The scale
was designed so that health workers other than clinicians, such as
home visitors, could administer this screening and then make the
appropriate referral. This screening can be both completed and scored
quickly because there are only ten questions and the scoring system is
ideation. They noticed that item one (I have been able to laugh and
see the funny side of things), item two (I have looked forward with
enjoyment to things), and item seven (I have been so unhappy that I
have difficulty sleeping) are also related. It is possible that these
items are related because they comment on hopelessness, which has
been defined by Beck et al. (1990) as a predictor of eventual suicide.
Still, there is no preferred screening tool (Zhong et al., 2014).
Studies have compared the Edinburgh against different tools and have
found different results. For example, in Zhong et al.s study (2014), the
Patient Health Questionnaire found more participants with suicidal
ideation than the Edinburgh did with the same participants (15.8 vs.
8.8%). On the other hand, Mauri, Oppo, Borri, and Banti (2011) found
that the Edinburgh showed a higher prevalence of suicidality than the
Mood Spectrum Self Report tool (12.0 vs. 6.9%). A number of different
explanations may be relevant. For one, though Cox, Holden, and
Sagovsky (1987) defined 12/13 as cut off scores for the Edinburgh,
there is not a consensus among researchers on which point to use as a
cut off. Secondly, not all women are screened at the same time during
the peripartum period. The differing rate of prevalence may be due to
simply the change in a womans mental health state with the passage
of time. The Edinburgh also only asks about suicidal ideation using the
passive tone. The Patient Health Questionnaire, however, asks about
suicide in both the active and the passive tone, which may resonate
10
References
American Psychiatric Association (2013). Diagnostic and statistical
manual of
mental disorders (5th ed.). Arlington, VA: American Psychiatric
Publishing.
Beck, A. T., Brown, G., Berchick, R. J., Stewart, B. L., and Steer, R. A.
(1990).
Relationship between hopelessness and ultimate suicide: A
replication with
psychiatric outpatients. The American Journal of Psychiatry, 147,
190-195.
Bergink, V., Burgerhout, K.M., Koorengevel, K. M., Kamperman, A. M.,
Hoogendijk, W.
J., Lambregtse-van den Berg, M. P., and Kushner, S. A. (2015).
Treatment of
psychosis and mania in the postpartum period. Treatment in
Psychiatry, 172,
115-123.
Cohen L. S., Wang, B., Nonacs, R., Viguera, A. C., Lemon, E. L., and
Freeman, M. P.
11
12
Sit, D., Seltman, H., and Wisner, K.L. (2011). Seasonal effects on
depression risk and
suicidal symptoms in postpartum women. Depression and
Anxiety, 28, 400405.
St. Pierre, C. M. (2007). The taboo of motherhood depression.
International Journal
for Human Caring, 11(2), 22-31.
Zhong, Q. Y., Gelaye, B., Rondon, M. B., Sanchez, S. E., Simon, G. E.,
Henderson, D.
C.,Williams, M.A. (2014). Using the Patient Health
Questionnaire (PHQ-9)
and the Edinburgh Postnatal Depression Scale (EPDS) to assess
suicidal
ideation among pregnant women in Lima, Peru. Archives of
Womens Mental
Health, no page specified.