September 10, 2007

Postpartum depression risk assessment during pregnancy

I just love the The Postpartum Stress Center site. One great tool on the site is a PPD risk assessment for women who are pregnant or planning to be pregnant. It's a good way to become educated on various factors that could predispose you to experiencing a postpartum mood disorder. For example, the following are some of the factors listed in the assessment:

- I have had a previous episode of postpartum depression and/or anxiety that was successfully treated with therapy and/or medication.

- I might have experienced symptoms of postpartum depression following previous births, but I never sought professional help.

- I have had one or more pregnancy losses.

- I have a history of depression/anxiety that was not related to childbirth.

- I have lost a child.

- I have been a victim of the following:
Childhood sexual abuse
Childhood physical abuse
Physical assault by someone I know
Physical assault by a stranger
Physical assault during this pregnancy
Sexual assault by someone I know
Sexual assault by a stranger

- There is a family history of depression/anxiety, treated or untreated.

- I have a history of severe PMS.

- I do not have a strong support system to help me if I need it.

- I have a history of drug or alcohol abuse.

- People have told me I'm a perfectionist.

- During the past year, I have experienced an unusual amount of stress (ex: Move, job loss, divorce, loss of loved one)

I find this list so interesting and wish I'd had it back in the day. For example, the perfectionist issue -- who would have thought that being a perfectionist could raise your risk for having PPD? But, I can totally see it and how that overwhelming feeling that you're not doing everything you should be doing for your newborn, the household, other kids who need your attention, etc., etc., is devastating to a perfectionist who is used to having everything all put together perfectly.

And what about a history of severe PMS? That's such a huge and common issue. According to the American College of Obstetricians and Gynecologists, approximately 40% of women experience PMS on a consistent basis. And nearly 85% of women will experience one or more of the symptoms over the course of their reproductive life. But do these women realize that having PMS may be a factor that puts them at higher risk for PPD?

And of course the support system issue is a biggy and I've written about it before because it's something I've experienced personally -- both the lack of support and having support. For me, not having a strong support system was the overriding factor when I suffered from PPD. I felt like I was screaming out for help but no one was hearing me. It was horrible feeling so utterly alone and it nearly did me in. But with my subsequent pregnancy here in Arizona, when I had an overwhelmingly strong support system in place, my postpartum was wonderful. When pregnant women are busy filling a nursery with furniture, bedding, diapers, and other essentials, what they really need to be doing is filling up their support system with friends and family who are willing to pitch in with meals, household help, supportive phone calls, shopping assistance, birth announcements and more.

I could write all day about the above list. Most importantly, I want to applaud The Postpartum Stress Center for creating its eye-opening PPD Risk Assessment During Pregnancy. I think every pregnant woman should take a look at it. If you're not familiar with The Postpartum Stress Center, it was founded in 1988 by the wonderful Karen Kleiman, MSW, and received Postpartum Support International's Jane Honikman Award in 2003.


Lisel said...

I wish every OB was required to go through this checklist before giving birth or at the 6 week postpartum checklist. If I had had these questions asked and realized that I was at a particular risk for PPD, I would asked for an antidepressant immediately after delivery and for a reference to a psychiatrist for follow up.
I think OB's do not take PPD as seriously as they need to. They hear a mother say she's blue, they write the script and that's it. My father-in-law is an OB and I have heard him many times talk about how patients come to him for antidepressants and he seems to pass them out like candy with no real assessment of the situation.

Kristin said...

I completely agree with you, Lisel. It's very scary how so many OB's consider their job done when the baby is born. And the fact that they prescribe brain medication when brains are not at all their specialty.

I really think that all OB practices need to have a psychologist and/or a psychiatric nurse practitioner on staff to provide an assessment like this to all pregnant women, and also to follow up closely after each birth. I know that would have saved me and my family several long months of suffering, not to mention all of the unnecessary hospital/medical bills that I racked up during that time.

Makes me want to scream if I think about it too much.

Warmest regards,

Stanley Poulos said...

Women are more likely than men to suffer from depression, especially during their reproductive years. Rates of depression are higher where stressful circumstances exist such as poverty, lack of education, sexual inequality, poor social support and in pregnancy. Single and adolescent pregnant women are especially at risk.

Daniel J. Casper said...

Pregnancy is one of the most important phases of a woman's life and unfortunately sometimes in this phase a woman gets caught in the web of depression. Though depression during pregnancy is not uncommon, it can be dangerous for both the mother and the unborn baby.