Perinatal Mood Disorders

1
Perinatal Mood Disorders

• Katie Leon
• Visiting Nurse Services
• In Conjunction with
• Iowa Department of Public Health
• Maternal Depression Screening
• Program

2
The Societal Burden of Depression

• Current research shows that approximately 18.4
  of pregnant women and as many as 19.2 of new
  mothers experience clinically significant
  symptoms of depression.
• Postpartum depression is often overlooked and
  under treated.

3
The Societal Burden of Depression

• In the United States, depression is the leading
  cause of non-obstetric hospitalizations among
  women aged 18-44.
• In the year 2000, 205,000 women aged 18-44 were
  discharged with a diagnosis of depression
• Seven percent of all hospitalizations among young
  women were for depression

4
Purpose of Training

• Healthy Start/Empowerment serves women who are
  pregnant and/or have young children
• Many of our families are at a higher risk for
  becoming depressed based on specific demographic
  or social characteristics low social status,
  presence of stressful life events, few supportive
  relationships, African American ethnicity,
  history of mental illness and so on
• The purpose of this training is to teach you
  about maternal depression and maternal depression
  screening

5
Overview of Training

• During this training we will discuss perinatal
  mood disorders and the effects of postpartum
  depression on the mother and the child
• We will discuss the importance of screening and
  how to effectively screen and make referrals for
  perinatal depression
• We will briefly discuss the available treatment
  of perinatal depression
• Finally, we will discuss mood assessment
  interviews
• Logistics of training (breaks, restrooms,
  evaluations.

6
The EPDS is Not a Magic Wand

• It is essential to understand maternal depression
  in order to effectively screen for it.
• While the EPDS is a relatively simple tool, it is
  imperative that you understand the disorder so
  that you can more accurately administer it and
  interpret the results of a screening.
• The EPDS is clearly not a magic wand to be
  distributed for compulsory use without training.
  Alone it is just a piece of paper, a checklist
  quote from Sandra Elliot (psychologist from UK)

7
Perinatal Mood Disorders

• There is a continuum of severity with perinatal
  mood disorders
• The Blues
• Postpartum Depression
• Postpartum Psychosis

8
Postpartum Blues

• Known as the blues this disorder is fairly mild
  and relatively brief.
• Many women experience the blues estimates of
  prevalence range from 15-84 depending on the
  definitions and measurements used in study
• Symptoms begin within a few days of delivery and
  can last from a few hours to a few days.

9
Postpartum Blues

• Symptoms include sad feelings, irritable mood,
  interpersonal hypersensitivity, crying, insomnia
  and anxiety
• Major concern raised by a case of the blues is
  its association with the increased risk for
  postpartum depression

10
Postpartum Psychosis

• The most severe and rare of the perinatal mood
  disorders
• Occurrs in 1-2 women per 1000 following delivery
• Drastically impairs the womens ability to
  function normally
• Usually occurs w/in first two weeks of delivery

11
Postpartum Psychosis

• Symptoms include delusions (false beliefs),
  hallucinations (seeing or hearing things that are
  not there), severely depressed mood, or
  confusion.
• Risk factors include history of Bipolar
  Affective Disorder, family history of psychosis
  and having first child
• With a personal history of bipolar disorder
  prevalence increases to 1/2
• Increases future risk of postpartum psychosis
• Andrea Yates

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Postpartum Depression

• Postpartum Depression falls in the middle on the
  continuum of postpartum mood disorders.
• Symptoms can range from mild to severe
• PPD is often not detected

13
Where is the snake?
14
The Prevalence/Societal Burden of Postpartum
Depression

• Approximately 500,000 of the 4 million American
  women giving birth each year experience
  postpartum depression (13)

15
Major Depression Diagnostic Criteria

• Woman must have at least five of the following
  depressive symptoms including
• Depressed mood
• Loss of interest in almost all activities
• Disturbances in sleep
• Significant weight loss or gain
• Agitation or very slow movements
• Fatigue or loss of energy
• Feelings of worthlessness or inappropriate guilt
• Inability to concentrate or make decisions
• Recurrent thoughts of death
• These symptoms must have been present for the
  same two-week period and represent a change from
  previous functioning.
• PPD does not have separate criteria from major
  depression it just identifies when the symptoms
  occur

16
Postpartum DepressionRisk Factors

• Poor marital relationships
• Limited social supports
• History of depression of individual or family
  member
• Lower SES
• Presence of stressful life events
• Child-care related stressors
• African American ethinicity