Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2016-0034
Trends in Psychiatry and Psychotherapy
Review Article

Screening and diagnosing postpartum depression: when and how?

Triagem e diagnóstico de depressão pós-parto: quando e como?

Gustavo Paranhos de Albuquerque Moraes; Laura Lorenzo; Gabriela Arruda Reinaux Pontes; Maria Cristina Montenegro; Amaury Cantilino

http://dx.doi.org/10.1590/2237-6089-2016-0034 Trends Psychiatry Psychother, vol.39, n1, p.54-61, 2017
PDF
SciELO
Downloads: 0
Views: 517

Abstract

Abstract Introduction: Prevalence rates of postpartum depression (PPD) vary widely, depending on the methodological parameters used in studies: differences in study populations, diagnostic methods, and postpartum time frame. There is also no consensus on the ideal time to perform screening, on whether PPD can only be diagnosed in the early postnatal period, or on how soon after a delivery depression may be related to it. Objective: To review which instruments have been used over recent years to screen and diagnose PPD and the prevailing periods of diagnosis. Methods: Only articles published within 5 years and related exclusively to screening and diagnosis were selected. The sample comprised 22 articles. Results: The Edinburgh Posnatal Depression Scale (EPDS) was the most common screening tool, used in 68% of the sample (15 articles), followed by the Beck Depression Inventory (BDI-II) (27%, 6 articles), and the Patient Health Questionnaire-9 (PHQ-9) (18%, 4 articles). Screening time frame was reported in 21/22 articles: 0 to 3 months postpartum in 9 (43%), up to 6 months in 4 (19%), and up to 12 months or more in 8 (38%). In short, 13 articles screened during the first 6 months (59%) while only 8 (36%) screened up to 1 year. Conclusion: The most frequent PPD diagnosis tool was the EPDS, but other scales were also used. The most common period for diagnosis was up to 3 months postpartum. However, some researchers diagnosed PPD 12 months or more postpartum. Greater standardization of parameters for investigation of this disease is needed.

Keywords

Postpartum depression, perinatal depression, postnatal depression, screening, diagnosis

Resumo

Resumo Introdução: A prevalência de depressão pós-parto (DPP) varia consideravelmente dependendo dos parâmetros metodológicos utilizados: diferentes populações, métodos de diagnóstico e o tempo pós-parto considerado. Também não há consenso sobre o momento ideal para a triagem, se a DPP pode ser diagnosticada apenas no período puerperal, e por quanto tempo após o parto a depressão pode ser relacionada a ele. Objetivo: Revisar os instrumentos mais usados recentemente para rastreamento e diagnóstico de DPP e os períodos predominantes de diagnóstico. Métodos: Foram selecionados apenas artigos relacionados exclusivamente ao rastreio e diagnóstico publicados num período de 5 anos. A amostra incluiu 22 artigos. Resultados: A Escala de Depressão Pós-Parto de Edimburgo (EPDS) foi a ferramenta mais frequente, utilizada em 68% da amostra (15 artigos), seguida pelo Inventário de Depressão de Beck (27%, 6 artigos) e o Patient Health Questionnaire-9 (PHQ-9) (18%, 4 artigos). O tempo de rastreio foi definido em 21/22 artigos: 0-3 meses pós-parto em 9 (43%), < 6 meses em 4 (19%), e ≤ 12 meses em 8 (38%). Treze artigos selecionaram as mulheres durante os primeiros 6 meses (59%), enquanto apenas 8 (36%) o fizeram até 1 ano. Conclusão: A EPDS foi o instrumento mais utilizado para o diagnóstico de DPP, mas outras escalas também foram aplicadas. O período mais comum para o diagnóstico foi de < 3 meses pós-parto. No entanto, alguns pesquisadores consideraram o diagnóstico de PPD em ≤ 12 meses após o parto. Há necessidade de maior padronização de parâmetros em relação à investigação desta doença.

Palavras-chave

Depressão pós-parto, depressão perinatal, triagem, diagnóstico

References

Miller LJ. Postpartum depression. JAMA. 2002;287:762-5.

Pereira PK, Lovisi GM. Prevalência da depressão gestacional e fatores associados. Rev Psiquiatr Clin. 2008;35:144-53.

Cantilino A. Por um consenso conceitual e metodológico nas pesquisas em depressão pós-parto. J Bras Psiquiatr. 2010;59:257.

Goodman JH, Tyer-Viola L. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Womens Health (Larchmt). 2010;19:477-90.

Moraes IG, Pinheiro RT, Silva RA, Horta BL, Sousa PL, Faria AD. Prevalence of postpartum depression and associated factors. Rev Saude Publica. 2006;40:65-70.

Robinson GE, Stewart DE. Psychological aspects of women's health care. Postpartum disorders. 2001:117-39.

Hayes DK, Ta VM, Hurwitz EL, Mitchell-Box KM, Fuddy LJ. Disparities in self-reported postpartum depression among Asian, Hawaiian, and Pacific Islander Women in Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2007. Matern Child Health J. 2010;14:765-73.

Lobato G, Moraes CL, Reichenheim ME. Magnitude da depressão pós-parto no Brasil uma revisão sistemática. Rev Bras Saude Mater Infant. 2011;11:369-79.

Dubey C, Gupta N, Bhasin S, Muthal RA, Arora R. Prevalence and associated risk factors for postpartum depression in women attending a tertiary hospital, Delhi, India. Int J Soc Psychiatry. 2012;58:577-80.

Divakar H, Girish N, Gururaj G. Use of Edinborough Postnatal Depression Scale (EPDS) in a private obstetrics setting. J Obstet Gynecol India. 2008;58:41-4.

Lobato G, Moraes CL, Dias AS, Reichenheim ME. Postpartum depression according to time frames and sub-groups a survey in primary health care settings in Rio de Janeiro, Brazil. Arch Womens Ment Health. 2011;14:187-93.

Flynn HA, Sexton M, Ratliff S, Porter K, Zivin K. Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services. Psychiatry Res. 2011;187:130-4.

The American College of Obstetricians and Gynecologists Committee Opinion no 630. Screening for perinatal depression. Obstet Gynecol. 2015;125:1268-71.

First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP). 2002.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E. The Mini-International Neuropsychiatric Interview (M I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22-33.

Zubaran C, Foresti K, Schumacher MV, Amoretti AL, Thorell MR, Müller LC. The correlation between postpartum depression and health status. Matern Child Health J. 2010;14:751-7.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses the PRISMA statement. BMJ. 2009;339:b2535.

Moraes GP. Revisão sistemática dos parâmetros metodológicos utilizados nos artigos científicos sobre os instrumentos de pesquisa e o tempo relacionados a triagem, diagnóstico e avaliação da depressão pós-parto (dissertation). 2015.

Horowitz JA, Murphy CA, Gregory KE, Wojcik J. Best practices community-based postpartum depression screening: results from the CARE study. Psychiatr Serv. 2009;60:1432-4.

Miller L, Shade M, Vasireddy V. Beyond screening assessment of perinatal depression in a perinatal care setting. Arch Womens Ment Health. 2009;12:329-34.

Shelton NJ, Herrick KG. Comparison of scoring methods and thresholds of the General Health Questionnaire-12 with the Edinburgh Postnatal Depression Scale in English women. Public Health. 2009;123:789-93.

Yawn BP, Pace W, Wollan PC, Bertram S, Kurland M, Graham D. Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to assess increased risk of depression among postpartum women. J Am Board Fam Med. 2009;22:483-91.

O'Mahen HA, Flynn HA, Chermack S, Marcus S. Illness perceptions associated with perinatal depression treatment use. Arch Womens Ment Health. 2009;12:447-50.

Phillips J, Charles M, Sharpe L, Matthey S. Validation of the subscales of the Edinburgh Postnatal Depression Scale in a sample of women with unsettled infants. J Affect Disord. 2009;118:101-12.

Lau Y, Wong DF, Chan KS. The utility of screening for perinatal depression in the second trimester among Chinese a three-wave prospective longitudinal study. Arch Womens Ment Health. 2010;13:153-64.

Flynn HA, Sexton M, Ratliff S, Porter K, Zivin K. Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services. Psychiatry Res. 2011;187:130-4.

Gjerdingen D, McGovern P, Center B. Problems with a diagnostic depression interview in a postpartum depression trial. J Am Board Fam Med. 2011;24:187-93.

Reichenheim ME, Moraes CL, Oliveira AS, Lobato G. Revisiting the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS) empirical evidence for a general factor. BMC Med Res Methodol. 2011;11:93.

Christensen AL, Stuart EA, Perry DF, Le HN. Unintended pregnancy and perinatal depression trajectories in low-income, high-risk Hispanic immigrants. Prev Sci. 2011;12:289-99.

Tandon SD, Cluxton-Keller F, Leis J, Le HN, Perry DF. A comparison of three screening tools to identify perinatal depression among low-income African American women. J Affect Disord. 2012;136:155-62.

O'Hara MW, Stuart S, Watson D, Dietz PM, Farr SL, D'Angelo D. Brief scales to detect postpartum depression and anxiety symptoms. J Womens Health (Larchmt). 2012;21:1237-43.

Mann R, Adamson J, Gilbody SM. Diagnostic accuracy of case-finding questions to identify perinatal depression. CMAJ. 2012;184:E424-30.

Kim HG, Geppert J, Quan T, Bracha Y, Lupo V, Cutts DB. Screening for postpartum depression among low-income mothers using an interactive voice response system. Matern Child Health J. 2012;16:921-8.

Maia BR, Pereira AT, Marques M, Bos S, Soares MJ, Valente J. The role of perfectionism in postpartum depression and symptomatology. Arch Womens Ment Health. 2012;15:459-68.

Čuržik D, Begić NJ. The utility of BDI-II in assessment of pre- and postpartum depression symptoms and their relation to labor pain. Psychiatr Danub. 2012;24:167-74.

Apter G, Devouche E, Gratier M, Valente M, Nestour AL. What lies behind postnatal depression is it only a mood disorder?. J Pers Disord. 2012;26:357-67.

Baines T, Wittkowski A, Wieck A. Illness perceptions in mothers with postpartum depression. Midwifery. 2013;29:779-86.

Beck CT. The effects of postpartum depression on maternal-infant interaction a meta-analysis. Nurs Res. 1995;44:298-304.

Whiffen VE. Screening for postpartum depression a methodological note. J Clin Psychol. 1988;44:367-71.

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6.

Boyd RC, Le HN, Somberg R. Review of screening instruments for postpartum depression. Arch Womens Ment Health. 2005;8:141-53.

Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand. 2009;119:350-64.

Harvey ST, Pun PK. Analysis of positive Edinburgh Depression Scale referrals to a consultation liaison psychiatric service in a two-year period. Int J Ment Health Nurs. 2007;16:161-7.

Elisei S, Lucarini E, Murgia N, Ferranti L, Attademo L. Perinatal depression a study of prevalence and of risk and protective factors. Psychiatr Danub. 2013;25:S258-62.

Figueira P, Corrêa H, Malloy-Diniz L, Romano-Silva MA. Edinburgh Postnatal Depression Scale for screening in the public health system. Rev Saude Publica. 2009;43:79-84.

Murray L, Carothers AD. The validation of the Edinburgh Post-natal Depression Scale on a community sample. Br J Psychiatry. 1990;157:288-90.

O'Hara MW, Swain AM. Rates and risk of postpartum depression a meta-analysis. Int Rev Psychiatry. 1996;8:37-54.

Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G. Perinatal depression prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ). 2005;119:1-8.

Lucero NB, Beckstrand RL, Callister LC, Sanchez Birkhead AC. Prevalence of postpartum depression among Hispanic immigrant women. J Am Acad Nurse Pract. 2012;24:726-34.

Chaudron LH, Szilagyi PG, Tang W, Anson E, Talbot NL, Wadkins HI. Accuracy of depression screening tools for identifying postpartum depression among urban mothers. Pediatrics. 2010;125:e609-17.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). 1994.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 2013.

Cox J. Postnatal mental disorder towards ICD-11. World Psychiatry. 2004;3:96-7.

O'Hara MW, McCabe JE. Postpartum depression current status and future directions. Annu Rev Clin Psychol. 2013;9:379-407.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and postpartum women evidence report and systematic review for the US preventive services task force. JAMA. 2016;315:388-406.

6169ccf0a9539553e5002e33 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections