Detecting depression in new mothers
by Mark Derewicz
When a nurse practitioner asked my wife questions about her emotional state two weeks after the birth of our son, I knew she was just checking for signs of postpartum depression. I figured such questions were common for new mothers. I was wrong.
Betsy Sleath,
a researcher in the School of Pharmacy, sent 1,200 surveys to obstetricians, gynecologists, and family practitioners across North Carolina, and from the 491 respondents, 228 had seen women for postpartum visits in the last three months, and 79 percent of these doctors were unlikely to screen patients for postpartum depression.
“I was really surprised that more doctors are not using the formal screening instruments that are out there,” Sleath says. The Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire 9 can be found with a quick internet search, and patients could fill out the forms in the waiting room before seeing the doctor. As for one-on-one consultation, Sleath says that doctors are under a lot of pressure to focus on physical health instead of mental well-being.
“And North Carolina is not unique, because for years, postpartum depression care has focused solely on the mother’sphysical health,” she says. “But one out of nine new mothers has postpartum depression. I think that’s a pretty striking number.”
UNC psychiatrist Bradley Gaynes, co-author of Sleath’s study, says that at the very least, doctors should ask all new mothers two basic questions: “Do you feel sad or depressed?” and “Are you disinterested in usual activities?”
But only 43 percent of doctors were almost certain to ask mothers if they feel depressed or sad, and just 27 percent said they ask if new mothers are interested in their normal daily activities.
Some scientists say that changes in hormone levels after pregnancy are the likely cause of postpartum depression, and new mothers or women who lose their babies due to stillbirth or miscarriage are at greater risk if they have a history of depression, have poor support from their partners, friends, and family, or are under significant additional stress. Symptoms include extreme fatigue, loss of pleasure in daily life, sleeplessness, sadness, anxiety, hopelessness, feelings of worthlessness and guilt, irritability, appetite change, and poor concentration.
“Depression during the perinatal period can have devastating consequences, not only for the women experiencing it but also for the women’s children and families,” Gaynes says. “It’s a disease that affects more than just the new mother.”
One way to make sure postpartum depression doesn’t spiral out of control is for new mothers to talk about how they feel, if not first with their doctors then with their partners, friends, and family. That’s not easy, Sleath says, because there’s a stigma attached to postpartum depression. Women who suffer from it typically feel ashamed that they’re depressed during such a special time. But if women don’t talk and doctors don’t ask, then new mothers who need treatment might never get it.
After Sleath talked about this stigmatization during a radio interview, friends approached her for the first time about their own battles with depression. “They told me they felt more open to talk to me after they heard me talk about the stigma and how women shouldn’t be ashamed.”
Betsy Sleath is an associate professor in the School of Pharmacy and a research associate at the Cecil G. Sheps Center for Heath Services Research. Bradley Gaynes is an associate professor of psychiatry in the School of Medicine.
Learn more:
- betsy sleath
- wral covers sleath’s study
- browse our archive for more Endeavors stories in pharmacy
