Gynaecologists are not psychiatrists...but are key in perinatal depression diagnosis

Perinatal depression is one of the most common complications of childbirth. Its impact can be enormous for affected families so it's important to screen all new mothers.

Key issues about depression screening:

Every woman who has given birth should be screened for mental health symptoms at her follow-up appointment.
This includes depressive disorders as well as anxiety disorders.
Using a standardised tool, such as a questionnaire, is ideal.
Patients who have signs of perinatal depression, anxiety disorder or other mental illness should be referred to a psychiatrist or therapist.
The emotional experience of expectant and new mothers should be normalised and addressed before birth.

Normalising mixed emotions

According to leading American gynaecologists, almost every new mother experiences a rollercoaster of emotions - these include joy, but also sadness. The vacillation between feeling in control and feeling hopelessly overwhelmed. This does not yet mean that every one of these women also suffers from postpartum depression.

Nevertheless, the country's leading gynaecologists emphasise that it makes sense to address this wide range of possible feelings. Not only do pregnant women then feel better prepared - it also paves the way for being able to address the emotional state more openly. The presence of feelings with negative connotations is thus de-tabooised and normalised.

One screening for all cases

In the USA, mothers are screened for depressive symptoms six weeks postpartum as standard. This is done using a standardised questionnaire. But the ACOG describes that many gynaecologists are not sufficiently trained to recognise perinatal depression or anxiety disorder - or do not know what to do if there are abnormalities.

Nevertheless, screening is essential, even if everyday gynaecological practice is stressful enough with basic and standard care.

Early treatment prevents complications

The first days with the baby are of particular importance. If the mother suffers from depressive symptoms or anxiety attacks, this affects the whole family. Therefore, referral to a psychiatrist or therapist should be made in case of abnormalities. This is especially true for women who already have a history of depression, suicidal tendencies or other psychiatric illnesses. It may be useful to start antidepressant therapy before seeing a doctor for further treatment.

Not every depressive mood is a perinatal depression - but anything that lasts longer than two weeks or is even accompanied by tendencies to self-harm or other symptoms should definitely be treated through psychiatric support.

Conclusion for medical practice

Talk to your pregnant patients, also before birth, about the great variety of feelings that come with a new baby. This makes it easier to address possible abnormalities later on. It is also worth keeping an eye on the moods of young mothers - even if the baby is almost a year old. Don't hesitate to bring a therapist or psychiatrist on board, as extra precautions are of great benefit for patients.

References

https://www.acog.org/news/frontline-voices/2022/12/how-i-incorporated-patients-mental-health-care-into-routine-practice
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression