Assessing postnatal depression

After giving birth, up to 15% of people experience depression. Postnatal depression is typically diagnosed within 6 weeks postpartum; however, the principles in this section apply throughout the first postnatal year.

In addition to the features of major depression, common symptoms include difficulties coping with the infant, guilty thoughts about being a bad parent, excessive anxiety about infant wellbeing and irritability towards family. Comorbid anxiety (eg generalised anxiety, panic attacks, obsessive compulsive disorder [OCD]) is highly prevalent; identify and diagnose anxiety disorders to guide treatment; see Assessing a person with anxiety and Considerations in managing anxiety disorders during the perinatal period.

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item, self-reported questionnaire used to screen for depression at least once during the postnatal period (usually at 6 weeks) and may also assist assessment of depressive symptoms during this time. An EPDS score of 13 or higher indicates possible depression requiring further assessment. The EPDS can also help to monitor response to therapy—a change in score of 4 points or greater is considered meaningful.

The potential for harm through suicide or infanticide, or neglect or physical abuse to infants or other children is a major concern in postpartum depression. In Australia, suicide is a leading cause of death during the perinatal period, exceeding causes directly related to childbirth or its complications. Not all patients who experience suicidal thoughts have infanticidal thoughts. Some may erroneously believe that their symptoms cannot represent postnatal depression because they still have loving feelings for their infant. Take a tactful and sensitive approach in exploring symptomatology and determining whether the patient has:

• real intentions of self-harm or suicide (see Suicide risk)
• real intentions of harming the infant (see here for advice on determining the risk of infant harm)
• delusions that could place them or their infant at risk or suggest postpartum psychosis.

If the risk of harm to the patient or infant is high or cannot be determined, or postpartum psychosis is suspected, consider an urgent psychiatric assessment (eg by a community mental health team, in an emergency department).

In addition to the risks of suicide and infanticide, postnatal depression may impair the parent–infant relationship; there is some evidence that this may lead to poorer cognitive and behavioural outcomes in the child.

For further information and support for clinicians and patients, see the Perinatal Anxiety and Depression Australia (PANDA) website. The PANDA National Helpline (1300 726 306) provides risk assessment, support, counselling and information (including referral advice about local medical, mental health and family services).