Health care providers - Introduction
and symptoms of PPMD
mothers with PPMD
5 risk factors for PPMD
you can do
to your patient and validate her feelings
aware of barriers mothers face recognizing and/or disclosing
Postpartum Mood or Anxiety Disorders (PPMD) affect not only the mother but her child, her partner and the rest of her family. PPMD is not clinically different from a depression or anxiety that can occur at any time, but it may have greater ramifications, because much of the important psychological attachment between mother and infant is formed during the prenatal and postpartum period.
As a health care provider you have an important role in the detection, diagnosis, and treatment plan of your patients who develop PPMD. If left untreated, the risks for the mother include:
- Poor self-care
- Poor nutrition
- Sleep disturbance
- Substance abuse
- Increased and chronic anxiety and depression
- Interpersonal/family conflict
There are risks to the baby which can lead to abnormal infant attachment and behaviour as well as decreased and delayed cognitive development. The effects of these can be seen from early childhood through adolescence into adulthood.
Incidence and Symptoms of PPMD
PPMD can affect any mother. In fact 13% of new mothers will suffer a moderate to major episode of postpartum depression, the most common and most researched PPMD and more will experience other mild to moderate or severe mood or anxiety disorders such as anxiety, obsessive compulsive disorder, mania, neurosis and others.
Mothers will present with a variety of symptoms, many of them common occurrences after childbirth. [Also see,
PPMD Tear-off sheet]
- Up to 80% of mothers will experience postpartum blues.
- Up to 20% will experience a mild to severe postpartum mood disorder.
- 1 - 2 in 1000 will suffer a postpartum psychosis
[Top of the
The onset of postpartum psychosis is usually 48 hours to 2 weeks after birth, but can occur later, too. If a new mother is psychotic she may experience the following symptoms.
- Thinking and possibly planning of harming self or baby.
- Hearing or seeing things that are not there (hallucinations).
- Believing people or things are going to harm her or the baby (paranoia).
- Feeling confused and out of touch with reality (includes delusions).
This is a medical emergency. The mother needs treatment immediately and should not be left alone or alone with the baby until she has had a psychiatric assessment.
[Top of the
Recognizing Mothers with PPMD
Mothers with PPMD can present differently. The scenarios presented here may help you recognize some warning signs in your clients. Other warning signs can also be frequent visits or trips to their care provider with physical symptoms or concerns about the infant.
[Also see, Family and Friends section]
[Top of the
5 Risk Factors for PPMD
Depression or anxiety in pregnancy
Recent stressful life events (e.g., moving, relationship problems, death of a loved one).
Lack of social supports
Past personal history of mental illness
Family history of mental illness
Other risk factors include: maternal personality, low self-esteem, relationship difficulties, low socio-economic status (SES) or a change in SES and obstetric and pregnancy complications.
[Top of the
Screening and Diagnosis
There are different tools that can help assess a new mother's mental health. Health care providers can use the 4 PASS-CAN questions [see Desk Reference] or use another well-validated screening tool such as the:
The Edinburgh Postnatal Depression Scale (EPDS)
British Journal of Psychiatry June, 1987, Vol. 150 by J.L. Cox, J.M. Holden, R. Sagovsky.
The EPDS is a tool used to assist health care professionals in screening mothers for postpartum depression. It is internationally accepted by both researchers and health care providers. It is convenient to administer as it only takes a few minutes to fill out, it is easily incorporated into everyday clinical practice and has a high acceptability in diverse cultures. The EPDS may be used at 6-8 weeks to screen postnatal women. The child health clinic, postnatal check-up or a home visit may provide suitable opportunities for its completion. It can also be used during the prenatal period or at any time during the first year postpartum or beyond. During the first two weeks postpartum results should be viewed with caution because many mothers experience feelings of postpartum "blues".
The EPDS has been translated into 23 different languages. Caution should be exercised when using it with different ethnic populations as different cut-off scores have been suggested for different populations. Research has validated the tool with women speaking their native tongue in their native country.
[Also see, Edinburgh Postnatal Depression Scale (EPDS)]
[Top of the