Key Feature 11: In pregnant or postpartum patients, identify postpartum depression by screening for risk factors, monitoring patients at risk, and distinguishing postpartum depression from the “blues.’’ Skill: Selectivity, Clinical Reasoning
Phase: Hypothesis generation, Diagnosis
Routine assessment of mood and screening for depression is standard of care in pregnant and postpartum patients, given the well-recognized and common phenomenon of postpartum depression. Most clinicians I have seen providing prenatal care - each in their own way, at every prenatal encounter - ask how a woman is feeling and coping with the changes of pregnancy or with having a new infant. It is, after all, a big life change, and a time of significant stress for many. In the province of British Columbia, the act of screening for risk factors for postpartum depression is further affirmed by the BC prenatal record that includes the Edinburgh Postnatal Depression Scale, a screening test for depressed mood. It helps to identify women who may be suffering from depression and who are at increased risk for postpartum depression, and who may warrant more vigilant monitoring for associated symptoms, signs, and complications of depression in the antenatal and postpartum period.
The very common phenomenon known as “baby blues” is when mothers in the postpartum period experience symptoms of depression such as depressed mood, impaired concentration, fatigue, insomnia, etc., but do not meet the criteria for a diagnosis of depression. Commonly, they may be having difficulty coping with the new and very real stresses and demands of caring for a newborn, while having less time to care for themselves during a time when they could stand to benefit much from increased self-care. Unsurprisingly, this is a common phenomenon, and reassuring moms about this fact can be therapeutic in and off itself. While not meeting the criteria for clinical depression, the prognosis is one that is expected to run its course within a couple of weeks, without necessarily foreboding a future diagnosis of depression. That being said, patients with postpartum blues are at increased risk for depression, so clinicians overseeing their care should ensure there is regular and frequent followup to reassess how they are doing.