Screening for Depression in Pregnancy
Our team’s research:
Many pregnant women and new mothers fear postpartum depression. They’ve heard about the tragic stories of women with postpartum psychosis who harm themselves and their babies. They worry that it could happen to them, too.
Depression and anxiety are two of the most common complications in pregnancy. They are more common than diabetes and high blood pressure – two complications that doctors routinely screen for.
But, most physicians don’t ask pregnant women about their mood. In most countries, a mental health assessment is not a part of routine prenatal care. As a result, most pregnant women who need help for anxiety or depression don’t have the chance to get it.
Reasons to have mental health screening:
There are two reasons why all pregnant women should have access to mental health screening.
Prenatal depression and anxiety are as common as postpartum depression. They are also the biggest risk factors for postpartum depression.1
1 in 3 women who struggle with prenatal depression still have symptoms when their children go to Kindergarten if they don’t get help.2,3 If they don’t get screened, chances are they won’t get help.
You might not think that it really matters whether a doctor checks pregnant women for mental health problems. After all, the last time you had your yearly physical your doctor didn’t screen you for a cold or the flu. She knows that if you come down with symptoms and you need help, you’ll contact her.
Will patients tell their doctor they're struggling?
Up until now, we thought that if women needed help, they’d tell their doctor.
However, new research by our team at the University of Alberta shows that this is not true. There is a third reason we need to screen pregnant women for mental health problems.
We asked pregnant women whether they would raise concerns about their mental health with their doctor.4 This is what we found in our study of 460 women:
53% said no:
53% of women would not raise concerns about their mental health with their physician because they do not know what emotions are “normal” and “not normal” during pregnancy.
67% would prefer to talk to someone else:
67% would not initiate a conversation about mental health with their prenatal provider because they preferred to talk about their concerns with their partner, friend, or family.
44% didn't feel comfortable talking to medical staff:
44% said they would not want to be seen as “depressed” or “anxious” by their provider and therefore wouldn’t feel comfortable raising mental health issues on their own.
Many pregnant women simply won’t tell their doctor they are struggling:
Who was most likely to feel this way?
Women who had experienced depression or anxiety before they became pregnant. In other words, those who have the greatest risk for prenatal depression and anxiety.
A simple adjustment:
What surprised us, though, was that 99.8% of women said that if their doctor asked about their mental health, they would be honest! They’d feel comfortable responding to their doctor’s questions.
Should we screen pregnant women for depression and anxiety? If we don’t, many women won’t share their concerns. Many won’t get the help they need.
Further Information
References
Milgrom J, Gemmill AW, Bilszta JL, et al. Antenatal risk factors for postnatal depression: a large prospective study. Journal of affective disorders 2008;108:147-57.
Giallo R, Woolhouse H, Gartland D, Hiscock H, Brown S. The emotional-behavioural functioning of children exposed to maternal depressive symptoms across pregnancy and early childhood: a prospective Australian pregnancy cohort study. European child & adolescent psychiatry 2015.
van der Waerden J, Galera C, Saurel-Cubizolles MJ, Sutter-Dallay AL, Melchior M, the EM-CCSG. Predictors of persistent maternal depression trajectories in early childhood: results from the EDEN mother-child cohort study in France. Psychological medicine 2015:1-14.
Kingston D, Austin, M-P., Heaman, M., McDonald, S., Lasiuk, G., Sword, W., Giallo, R., Hegadoren, K., Vermeyden, L., Veldhuyzen van Zanten, S., Kingston, J., Jarema, K, Biringer, A. Barriers and facilitators of mental health screening in pregnancy. Journal of Affective Disorders 2015;accepted manuscri
