Screening for Anxiety or Depression in Pregnancy
Benefits of early detection of perinatal depression:
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.
What clinicians want help with:
Many clinicians have approached me with the following frustrations.
Wanting to know what screening tools to use to detect anxiety or depression in pregnant women;
How to help women who need and want help;
Frustration with the lack of services in the community (of almost 1-million people!) and the intolerable wait time to get women into one of the only existing services in the city.
This is not the first time I’ve heard these sentiments. This is the situation in North America for many primary care providers.
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 their 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.
Screening for depression:
NICE recommended the 2-question Patient Health Questionnaire (PHQ-2):
Q. 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.
Screening for anxiety:
NICE guidelines recommended the 2-questions Generalized Anxiety Questionnaire (GAD-2):
Q. Over the last 2 weeks, how often have you been bothered by the following problems:
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
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.
These tools are not perfect:
These tools are not perfect, none is! But, they are quite accurate and are brief enough to be used as a part of routine prenatal care. The best part is that our research shows that 99% of pregnant women who had not been screened for prenatal anxiety or depression wanted to be. In fact, in follow-up interviews, women told us they wanted to be routinely screened for emotional health – just like they had their blood pressure checked.
>> Check yourself for positive mental health here.
Help for pregnant women with anxiety, depression, or stress
Question: What type of help can I offer pregnant women so that they can get timely assistance?
Research shows that 95% of pregnant women with emotional health concerns experience mild- or moderate-degree symptoms.
That means that the vast majority of women can be effectively helped through online venues, which are cheaper, more available, and readily accessed than face-to-face sessions (which may not be an option in smaller communities).
The NICE guidelines suggest that there is enough evidence to recommend cognitive behaviour therapy (CBT) to pregnant women with mild- or moderate- symptoms.
Online CBT:
Some excellent options for general, online CBT programs (not specific for pregnant women) are:
ThisWayUp: Costs $60 for 6-week access to online CBT programs that target depression or anxiety.
My Compass: A free, personalized self-help online program that targets depression, anxiety or stress. Move through at your own pace. Plenty of great resources.
Another excellent option is an online CBT program is this the HOPE Mental Health 4 Women platform, our flagship program.
The last 5% of women who have more severe symptoms, and often co-existing challenges such as lack of support, interpersonal violence, or substance use, are best served by a combination of multidisciplinary services that may require coordination between a psychiatrist, family physician, psychologist, and/or social worker.
Further Information
Acronyms:
PHQ-2: Patient Health Questionnaire, used for depression.
GAD-2: Generalized Anxiety Questionnaire, used for anxiety.
