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Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.
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Clin Obstet Gynecol. 2009 September ; 52(3): 456–468. doi:10.1097/GRF.0b013e3181b5a57c.
The Identification of Postpartum Depression
Dorothy K. Sit, M.D.1 and Katherine L. Wisner, M.D., M.S.1

1University of Pittsburgh, Western Psychiatric Institute and Clinic
Abstract
Postpartum depression (PPD) is the most common medical complication of childbearing. Universal
screening maximizes the likelihood of prompt identification of PPD. Obstetrician-gynecologists
routinely evaluate postpartum women for a general health examination and review of family planning
options at approximately 6 weeks after birth; therefore, they are well-positioned to identify PPD. In
this paper, we review the diagnostic criteria for postpartum depressive disorders and clinical risk
factors predictive of PPD. We examine depression screening tools, appropriate cut-points associated
with positive screens, the optimal timing for screening and the acceptability of depression screening
in obstetrical settings. Lastly, we explore how to manage patients who screen positive for depression
and treatment options for women with PPD.
Keywords
postpartum depression; identification; screening tools
INTRODUCTION
Postpartum depresssion (PPD) is the most common medical complication of childbearing. PPD
occurs in 10 to 15% of new mothers (1). Groups of women at higher risk include inner city
women (50–60%)(2), mothers of pre-term infants (3) and adolescents (4,5). Depression after
delivery persists for more than 7 months in 25–50% of women (6,7). Lengthy post-birth
depressive episodes may result in maternal social (8) or relational problems even after recovery
(7,9–11). Moreover, PPD is associated with increased chronic medical disorders (12) and risk-
related behaviors such as tobacco smoking (13) and alcohol abuse (14). Universal screening
is an optimal approach to detection of new mothers who are suffering from depression
following childbirth (15).
The substantial negative impact of PPD for mothers, infants, and their families has been
established (16,17). Competent maternal function is critically important for ensuring the
infant’s safety and well being. Difficult temperament, poor self-regulation and behavioral
problems have been observed in infants of depressed mothers (18). The depressed mother may
not experience a positive and satisfying relationship with her infant, which serves to offset the
stresses of newborn care and postpartum recovery (19). Maternal depression that disrupts the
relationship between the mother and her infant contributes to a higher risk for poor infant and
child developmental outcomes.
Obstetrician-gynecologists and midwives who evaluate postpartum women are a well-

positioned, crucial resource for the prevention, detection and treatment PPD. Most mothers
visit their obstetricians four to six weeks post-delivery for an examination and review of family
Correspondence: Dorothy K. Sit, M.D., Assistant Professor of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and
Clinic, 3811 O’Hara Street, Oxford Building 410, Pittsburgh, PA 15213, Phone: 412-246-5248, Fax: 412-246-6960, sitdk@upmc.edu.
Sit and Wisner Page 2
planning options. Several national and state-based agencies, such as the US Preventive Health
Task Force, 2002 (20), American College of Obstetricians and Gynecologists-ACOG, April
2008 (21), State of New Jersey http://www.njleg.state.nj.us/2006/Bills/PL06/12.HTM, and the
Michigan Quality Improvement Consortium (22) strongly advocate for routine screening to
improve the identification of depressed perinatal patients (20).
In this paper, we review the diagnostic criteria for postpartum depressive disorders, the
differential diagnosis and clinical risk factors that are predictive of PPD. We examine
depression screening tools, appropriate cut-points for positive screens, the optimal timing of
screening and the acceptability of depression screening in OB settings. Lastly, we explore how
to manage patients with positive screens, suicidality and PPD.
DIAGNOSIS and CLINICAL RISK FACTORS of PPD

Diagnosis
In the Diagnostic and Statistical Manual (DSM-IV)(23), an episode of major depression after
delivery is defined as two weeks or more of persistent: 1) depressed mood, or 2) loss of interest
in daily activities plus four associated symptoms (appetite disturbance, sleep disturbance,
psychomotor agitation or slowing, fatigue, feelings of worthlessness or inappropriate guilt,
poor concentration, suicidal ideation) that onset within 4 weeks after childbirth. PPD contrasts
with the transient symptoms of the “baby blues” - brief crying spells, irritability, nervousness,
poor sleep and emotional reactivity. The baby blues affect 75% of new mothers, onset within
1–2 days and resolve by 10 days post-delivery. Although presentations vary, mothers with
major depression typically describe a diminished pleasure in interacting with people or
formerly enjoyable activities as well as feelings of low self-efficacy (24) rather than having
depressed mood. Severe symptoms may include difficulty making simple decisions, anxiety,
agitation, poor self-care, intense hopelessness and suicidal ideation or plan. One example is a
tired mother who has a terrible appetite; lost 40 pounds after delivery; feels she is a bad mother;
cannot fall asleep even when the baby sleeps soundly; and worries incessantly about harm
befalling her family.
Differential Diagnosis
Mothers with rapid onset of intense mood disturbance, confusion, strange or delusional beliefs,
hallucinations and disorganized behaviors have symptoms of postpartum psychosis, which is
most commonly form of Bipolar Disorder (BD) (25). Within the first month of childbirth,
women who have BD are at the high risk for episode emergence than at any other point in the
life cycle (26)(RR=21.7)(27). BD is characterized by recurrent episodes of major depression
that alternate with episodes of mania or hypomania. Clinicians can recognize mania or
hypomania in patients with an elated, expansive or irritable mood, inflated self-esteem,

excessive activity or planning and distracted concentration. The episodes of mania often result
in poor judgment, impaired performance or disrupted relationships; whereas hypomanic
episodes may result in heightened creativity and productivity without impairment (28). A
helpful clinical tool to distinguish bipolar disorder from unipolar depression is the
WHIPLASHED mnemonic – see
http://www.psychiatrictimes.com/display/article/10168/55321; Ronald Pies, M.D. Bipolar
depression is suspected in the new mother who describes feeling wired or worse on
antidepressant therapy; hypomania (periods of elation or heightened energy); irritability or
hostility; psychomotor agitation or slowing; loaded family history (for bipolar disorder,
depression, alcohol use disorders), abrupt onset or resolution of depressive episodes, seasonal
patterns of depression; hypersomnia or hyperphagia; early age of first depressive illness; and
delusional beliefs (hallucinations or other psychotic symptoms).

Other illnesses that cause postpartum distress include anxiety disorders e.g. panic disorder or
obsessive compulsive disorder (OCD), schizophrenia and medical conditions such as
hyperthyroidism or hypothyroidism, which are addressed in excellent references (29–32). The
first post-natal months are a period of high risk for the onset of anxiety disorders (29,33). New
mothers with panic attacks have discrete, intense episodes of fear or discomfort that last 5–15
minutes along with symptoms of palpitations, sweating, shortness of breath, choking, nausea,
abdominal discomfort, dizziness, unsteadiness, numbness or tingling, chills, hot flashes, or a
fear of dying or losing control. The patients with panic disorder describe recurrent panic attacks
that are associated with a dread of future attacks; in severe cases, patients restrict their outside
activities due to fear of having a panic attack where help is unavailable (agoraphobia). One
patient reported that she only drives 1–2 miles to grocery-shop for her husband and children,
avoids bridges or tunnels which trigger panic attacks and feels intense anxiety when she is not
accompanied by a trusted family member.
OCD is characterized by intrusive thoughts and compulsive behaviors performed to relieve the
distress that stems from the intrusive thoughts. Symptoms last for more than one hour daily
and cause impaired function. The postpartum parent with OCD might check her healthy, full-
term baby every ten minutes throughout the night to make sure that the infant continues to
breathe, or count to 30 every time she diapers the baby to prevent some harm from occurring.
Other common intrusive thoughts center on a range of themes: contamination, causing harm,
offensive images, religious preoccupations and urges for symmetry or order. Compulsions
include cleaning or washing, checking, repeating, rearranging, hoarding, and mental rituals
like counting and praying.
New mothers with solely panic disorder or OCD do not describe a low or depressed mood and
are still able to enjoy their usual activities. However, women with depression during the
postpartum period may present with concurrent panic disorder or OCD. Patients with OCD are
distressed by their unwanted disturbing cognitions (ego-dystonic). This characteristic
distinguishes OCD patients from the patients with schizophrenia who have fixed unusual or
bizarre beliefs (delusional thoughts), hallucinations, disorganized thoughts or behaviors and
poor insight into their symptoms or illness. Since the symptoms of hyperthyroidism overlap
with anxiety and panic symptoms, women with the onset anxiety disorders after delivery
require thyroid function tests.
Predictors of PPD
Exploring the predictors of PPD during antepartum or early postnatal visits can uncover
maternal liability for depression (34–36). Predictors include previous episodes of major
depression, family history of depression (37) and depression during pregnancy (38). Other
important demographic and clinical data predictive of PPD are recent immigrant status (39),
increased stressful life events(40), history of childhood sexual abuse (36) and decision to stop
antidepressant therapy during pregnancy (41).
DEPRESSION SCREENING
“You can’t tell by looking” was the theme of The Perinatal Foundation’s Public Awareness
Campaign for Perinatal Mood Disorders (www.perinatalweb.org) to counter the myth that
depression can be diagnosed without a clinical examination. Universal depression screening
in outpatient settings improves detection rates compared to routine care (35.4% and 6.3%,
respectively; P=0.001) (42). Psychometric properties that define an excellent screening tool
are: sensitivity (the proportion of women with major depression who were true positives),
specificity (the proportion of non-depressed women who were true negatives) and the positive
predictive value (the probability that women with positive screens actually have a depressive
disorder).

Edinburgh Postnatal Depression Scale (EPDS)

The most common measure to screen for depression related to childbearing is the EPDS. This
self-report instrument contains ten items ranked from 0 to 3 that reflect the patient’s experience
over the past week. The EPDS has been validated extensively for use in the postpartum period
(43–45) and during pregnancy (21,46,47).
What is an appropriate cut-point?

An EPDS ≥13 is an acceptable cut-point for identifying women at risk for major depression in
clinical settings (43). With an EPDS score ≥13, 86% of postpartum women were diagnosed
with major or minor depression (sensitivity) by the Research Diagnostic interview
(specificity=78%, positive predictive=73%)(38). Screening of a community sample of women
4–6weeks post-delivery (n=400) identified 6% of screened patients with PPD confirmed by
the SCID (48). Also, an EPDS ≥13 corresponds with a Hamilton Rating Scale for Depression
(HRSD) ≥20 (49) which suggests a high probability for a major depressive episode (50). For
clinicians who wish to implement antenatal screening, the recommended cut-point is an
EPDS≥15 (47)(47,51,52). The higher threshold is clinically justified since increased scores
may be explained by transient stress unrelated to a depressive disorder, but related to normative
experiences of pregnancy (35).
When to screen?
The optimal time to screen for PPD is at the first postnatal obstetrical visit, since extensive
data suggest the onset of postpartum disorders occur within the first month of childbirth (26).
Patients who report the onset of symptoms within days of delivery (36,53) can be assessed by
telephone with the EPDS. The new mother who scores above the EPDS≥13 cut-point should
be scheduled for an earlier post-natal visit to review her mood symptoms and physical state.
Partner ratings
An important component of PPD may be the relational disorder in the marriage across domains
of lack of support, loss of emotional closeness and sexual dissatisfaction (54,55). For
postpartum mothers who are accompanied by supportive spouses, obtaining partner ratings of
symptom levels is another strategy to assess maternal depression (that reduces self-report bias).
The EPDS and EPDS-Partner (P) ratings (55) could be used in treatment sessions to probe each
partner’s experience of the mother’s depression. Of 101 couples who recently became parents,
investigators quantified symptom levels with the EPDS, EPDS-P, Beck Depression Inventory
(BDI) and HRSD (55). Their findings suggested very acceptable psychometric properties of
the EPDS-P. The internal consistency measurements on the Cronbach’s coefficient were
alpha=0.80 for EPDS-P (n=93) and alpha=0.85 for EPDS (n=90); retest scores were stable at
2 and 6 weeks; the EPDS-P at 2 weeks was significantly correlated with the HRSD at 6 weeks
(55). Therefore, the EPDS-P is another reliable measure of maternal depression after childbirth
and is predictive of maternal depression levels beyond the contribution of the EPDS.
Other Screening Instruments

The Center for Epidemiologic Studies of Depression instrument (CES-D) is a 20-item
questionnaire; scores ≥16 indicate depression based on symptoms in the last 7 days. CES-D
scores remain stable in the first year postpartum and are associated with the diagnostic status
of depressive disorders (56,57). The CES-D has been used extensively to screen for depression
in culturally diverse populations (56) and adolescent mothers (high sensitivity and specificity)
(58).
The 9-item depression module of the Patient Health Questionnaire (PHQ-9)(59) is another
common screening measure. Responses at 4 levels (not at all, several days, more than half the

days and nearly every day) apply to how the patient has felt in the past 2 weeks. The full PHQ
and the PHQ-9 (brief version) effectively identified patients with and without major depression
in primary care and obstetrical settings (59). The high sensitivity (88%) and specificity (88%)
assure the validity of the PHQ for identifying depression risk (59,60). However, further
validation data are needed for the evaluation of postpartum patients (61).
The Postpartum Depression Screening Scale (PDSS)(62,63) evolved from qualitative

interviews to explore the maternal experience after childbirth. Seven items comprise the initial
screening; patients with PDSS≥14 received an extensive survey of 28 additional items. Scores
≥60 suggest risk for major or minor depression; scores ≥80 are highly predictive of major
depression (62). The PDSS has been used effectively for telephone screening (64) and the
screening of women in Spanish speaking and American Native communities (65,66). Problems
with the cost per use (copyright) and high rates of false positive screens could restrict the utility
of this tool (61).
In a comprehensive review, Boyd et al,(67) identified additional instruments with good

psychometric properties to assess perinatal symptoms. These instruments included the General
Health Questionnaire (GHQ – used in general medical settings to assess psychiatric symptoms
in 4 subcategories of depression, anxiety/sleep, somatic symptoms and social functioning)
(68), Beck Depression Inventory (BDI I or II)(69) and the Inventory of Depressive
Symptomatology (IDS – 28-item self report OR 30-item clinician rated inventory)(70,71).
These instruments all had sufficient data that demonstrated validity among women who speak
different languages (67)(72). The EPDS and BDI correlated highly with anxiety measures;
high scores on either instrument could suggest risk for anxiety disorders also. To identify
additional psychiatric comorbidities, the GHQ may be a more helpful instrument (72). The IDS
is useful for assessments of inner city or other ethnic populations of women (69).
Is depression screening acceptable?

Acceptability is an important indicator of how likely patients will answer the questionnaire
that informs about their risk for depression and how likely clinicians will administer the
instrument. Researchers found similarly high rates of acceptability and willingness to complete
the EPDS among women who accompanied their children to pediatric visits (85%)(73) and
groups of English and non-English speaking mothers (90%)(74). Survey responders likely self-
select; therefore, the estimates of acceptability may be over-represented. No discomfort was
reported by 87% of women at low risk (EPDS<13) compared to only 64% of women with high
risk (EPDS≥13)(chi square=31.9 df=2 p<0.0001). Therefore, perception of discomfort with
screening is most closely related to depression risk.
In a study of the acceptability of antenatal and postnatal screening, patients and professionals
reported that the EPDS was “easy or fairly easy” to complete among 93.4% (n=860) of patients,
83% nurses (n=230), 76% (n=194) of midwives and only 71% (n=118) of GPs (75). Despite
evidence of the benefits of screening, only 54% of general practitioners incorporated routine
screening into their practice, compared to 89% or nurses and 68% of midwives (75). Changing
practice patterns may be difficult (73). Physicians often prefer the direct interviewing style,
may not recognize the efficiency of the screening tools and feel less need from further training
(75). Provider education may be necessary to improve awareness of the benefits and efficiency
of the screening tools.
Screening Recommendations
In ambulatory clinics, the EPDS is an appropriate self-report tool for depression screening.
The recommended cut-point to detect PPD is an EPDS≥13. The optimal time to screen is 4–6
weeks after delivery. For mothers with supportive partners, the EPDS-P is a helpful adjunctive

tool for assessing maternal depression. The CES-D is an acceptable instrument to use with new
adolescent mothers. In OB and primary care settings, the PHQ or GHQ are efficient tools for
identifying PPD and comorbid disorders. When screening is conducted for Spanish speaking
women, the PDSS may be a useful (albeit costly) instrument; for women belonging to ethnic
or minority communities, the IDS is an effective screening tool.
MANAGEMENT OF WOMEN WITH HIGH DEPRESSION SCORES

Patients with EPDS≥13 are at substantial risk for major depression and require prompt
depression care and treatment planning. Psychiatric treatment referral is indicated for patients
who have high depression levels, comorbid disorders or inadequate treatment response.
Women with severe symptoms, such as a score of 1 or more on item 10 (thoughts of self harm),
homicidal ideation, bizarre thoughts or disorganized behaviors, require referral to emergency
mental health services. Another ingredient to successful treatment is the availability of a
depression care manager. The care manager can be a clinic-based professional (nurse or
experienced clinician) who provides education and telephone support to patients, coordinates
care and identifies resources that help to circumvent treatment barriers e.g. transportation,
insurance coverage, prescription fees. These depression care activities may be critical to
improved treatment outcomes.
Depression Care Model in the OB Setting

To understand the feasibility of depression screening in OB clinics (76), investigators

conducted a study of 233/293 (79.5%) university clinic patients and 593/708 (82.3%) private
patients who agreed to participate. The researchers identified depression risk (PHQ-9 score
≥10) in 40/47 (85%) and 26/48 (54%) of the participants respectively. Participants with
depression risk received an intervention that involved meeting a social worker (SW) who
provided depression education, arranged referrals and completed a 1-month follow-up call
(reached >90%). At the follow-up call, the SW explored the participants’ action taken to obtain
depression care, satisfaction levels and barriers to care. Compared to private patients, university
clinic patients preferred to receive depression care with their OB/GYN rather than other
providers. The patients, physicians and office staff in both settings felt highly satisfied with
the SW’s intervention. Follow through with referrals arranged by the SW was encouraging;
78% of the university clinic patients who received mental health referrals via the SW kept their
appointments. In contrast, fewer than half of patients followed through with referrals made by
the usual staff. The findings also highlighted critical information about barriers to care.
Common treatment barriers were concerns about others’ perceptions; and lack of efficient
transfer to psychiatric services (e.g. 17–25% of women had to contact their insurance company
independently to identify a participating provider). Many women (70% of private and 60% of
university based clinics) reported that they used internal resources or other sources for help
with managing depression rather than pursue professional treatment (74). This pilot model
suggests that routine screening and provision of a care manager are feasible and may improve
depression outcomes for OB patients in different settings.
Other Innovative Models of Depression Care

Investigators are exploring innovative solutions such as web-based depression screening and
home visitor programs to optimize the management of women at risk for PPD. In one
investigation, postpartum women were identified with depression risk (EPDS>9) from a web-
based program (n=701 out of 21,470 women)(77). Women assigned to receive support from
trained peer volunteers had a significantly lower risk for depression (EPDS>12)(14% - 40/297)
compared to women assigned to standard care (25%-78/315)(chi-square=12.5 p<0.001 NNT=8
95%CI=5.9–19.6). In another investigation (78), the depression risk (EPDS≥12) of patients
randomized to in-home psychotherapy skills training (cognitive behavioral or person-centered)

(12.4% 234/1880) was significantly lower than the risk of patients assigned to usual care
(16.7% 166/995)(odds ratio 0.67 95%CI=0.51–0.87 p=0.003)(78). These studies demonstrated
that innovative programs that expand the maternal support network may improve maternal
mood outcomes. The cost and cost-effectiveness of these programs still needs to be calculated.
TREATMENT OPTIONS FOR PPD

Once PPD is identified, rapidly implemented treatment is essential. Without prompt treatment,
patients are at risk for lengthy illness that could lead to impaired functioning, worsening
symptoms, treatment resistance and suicide. Similar to the management of major depressive
disorder outside of childbearing, the evidence-based mainstays of PPD treatment are focused
psychotherapy and/or antidepressant medication (79). In an elegant randomized control trial,
O’Hara et al. (80) found that interpersonal psychotherapy more effectively reduced depressive
symptoms than a wait-list control condition. For depressed adolescents, a combination of
fluoxetine and cognitive behavioral therapy was effective
(www.nimh.nih.gov/healthinformation/tads.cfm).
Antidepressants are efficacious for the treatment of PPD. Appleby et al. (81) found that
fluoxetine (20 mg/day) was significantly more effective than placebo. Sertraline prescribed at
50–200 mg/day induced remission (HRSD ≤7) in 14/21 (66%) of patients who completed an
8 week trial (82). Cohen et al. (83) found that venlafaxine (75–225 mg/day) resulted in an 80%
remission rate. In the only randomized comparative trial of antidepressants for women with
PPD, patients responded equivalently to treatment with the tricyclic agent nortriptyline and the
serotonin reuptake inhibitor sertraline (84). The majority of patients required dosing of
sertraline >100mg daily or nortriptyline ≥75mg daily for full response (84). Antidepressant
transmission through breast milk is a consideration in PPD treatment. Low or undetectable
levels of the majority of antidepressants have been found in infant sera, and no developmental
problems have been described (85)(and see this issue, Lanza di Scalia, 2009). Treatment choice
is best informed by the patient’s response to past treatment trials. Recommendations for the
clinical care of postpartum disorders and a decision-making model to assess risks and benefits
of antidepressant treatments are available (79)(85)(86)(87)(88).
Increasing the range of treatment options may improve the likelihood the patient will accept
treatment and reinforce her central role in choosing a treatment plan. Investigation of novel
therapies for childbearing women include bright light treatment, which is efficacious for both
seasonal and non-seasonal depression (89–91); nutritional intervention (92,93); essential fatty
acid supplements (94,95); regular aerobic exercise (96,97); and transdermal estradiol therapy
(see this issue - Moses-Kolko, 2009). Although the evidence base is not as extensive as for
psychotherapy and antidepressants, the availability of high-quality studies on promising new
therapies provides hope for women who decline standard treatments. Provision of novel
therapies allows establishment of a relationship which may pave the way for sequential
treatments if the chosen therapy does not result in achievement of the patients’ goals.
CONCLUSION
Routine depression screening in OB settings is an efficient and feasible method to improve the
identification of postpartum depressed patients with minimal risk for harm. The majority of
risk factors for the development of PPD are present during the antenatal period, underscoring
the importance of the medical history in the identification of high risk populations.
The EPDS is an acceptable instrument for routine screening. The recommended cut-point is
an EPDS≥13; the optimal time to screen for depression is 4–6 weeks after delivery. Patients
who score above this cut-point require prompt treatment planning and possible referral for
mental health care. The patient with suicidal ideation, thoughts to harm others or disorganized

behaviors requires emergency psychiatric services. Availability of a depression care manager,

who provides education, telephone support and coordinates referrals, is feasible and may
improve depression outcomes. Although the evidence-based mainstays of treatment are
focused psychotherapy and/or antidepressant medication, an increased range of treatments may

improve acceptability and bolster the patient’s role in planning her treatment.
ACKNOWLEDGMENTS
Dr. Sit’s contributions were supported by National Institute of Mental Health for the grants R01 MH60335 (PI: K.L.
Wisner) and K23 MH082114-01A2 (PI: D. Sit), and the International Society of Bipolar Disorders Fellowship Award
(PI: D. Sit). Dr. Wisner’s contributions were supported primarily by the National Institute of Mental Health for the
following grants: R01 MH60335, R01 MH071825 and R01 MH075921 (PI: K.L. Wisner). Dr. Wisner has also received
grant support from the Society for Bariatric Surgery, the Heinz Foundation, the New York—Mid-Atlantic Consortium
for Genetics and Newborn Screening Services, Novogyne, Pfizer, the Stanley Medical Research Foundation, and the
State of Pennsylvania.
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Clin Obstet Gynecol. 2009 September ; 52(3): 456–468. doi:10.1097/GRF.0b013e3181b5a57c.

The Identification of Postpartum Depression

Dorothy K. Sit, M.D.1 and Katherine L. Wisner, M.D., M.S.1

following childbirth (15).

Obstetrician-gynecologists and midwives who evaluate postpartum women are a well-

DIAGNOSIS and CLINICAL RISK FACTORS of PPD

hypomania in patients with an elated, expansive or irritable mood, inflated self-esteem,

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

Edinburgh Postnatal Depression Scale (EPDS)

What is an appropriate cut-point?

Other Screening Instruments

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

The Postpartum Depression Screening Scale (PDSS)(62,63) evolved from qualitative

In a comprehensive review, Boyd et al,(67) identified additional instruments with good

Is depression screening acceptable?

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

MANAGEMENT OF WOMEN WITH HIGH DEPRESSION SCORES

Depression Care Model in the OB Setting

To understand the feasibility of depression screening in OB clinics (76), investigators

Other Innovative Models of Depression Care

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

TREATMENT OPTIONS FOR PPD

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

behaviors requires emergency psychiatric services. Availability of a depression care manager,

focused psychotherapy and/or antidepressant medication, an increased range of treatments may

445–453. [PubMed: 7608357]

postpartum depression is not sufficient to improve the developing mother-child relationship.

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

duirng pregnancy. Can J Psychiatry 2004;49:726–735. [PubMed: 15633850]

mediational role of maternal self-efficacy. Child Development 1991;62(5):918–929. [PubMed:

Endocrinology 1997;15:77–89. [PubMed: 9065980]

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

Review of Psychiatry 1996;8(1):37–54.

depression. British Journal of Psychiatry 1989;154:813–817. [PubMed: 2597888]

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

MCN, American Journal of Maternal Child Nursing 2005;30(5):299–304.

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

Psychiatry. 2006 Oct;163(10):1843]. American Journal of Psychiatry 2006;163(6):986–991.

Clin Obstet Gynecol. Author manuscript; available in PMC 2010 September 1.

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