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Saturday, 16 November 2013
Learning Objective 1: Identify characteristics of two PMD screening tools available for use in the immediate postpartum period.
Learning Objective 2: Discuss a recommendation for use of both tools to identify high-risk mothers, based on the tools' level of agreement and factor analysis.
The global prevalence of Perinatal Mood Disorders (PMD) after giving birth has been reported as 13% in high-income countries and around 20% in low- and lower-middle-income countries. PMD are serious mental health problems that can lead to complications for mothers, newborns, and families. The 10-item Edinburgh Postnatal Depression Scale (EPDS), a PMD assessment instrument commonly used worldwide, asks questions regarding the mother’s symptoms and feelings over the past seven days. As a symptom-based instrument, it can be helpful for ongoing clinical monitoring of a mother at risk for PMD but may not always accurately detect depression risk. An 11-item Postpartum Depression Risk Assessment (PDRA) was collaboratively developed in 2006 by an interprofessional hospital-based team and is currently used in many maternal-infant units. The PDRA screens the mother’s risks for developing PMD based on past and current medical, emotional, and social history. Our nursing staff wondered if it was important to use both instruments so that no high-risk mother would be overlooked. We conducted a descriptive, comparative, IRB-exempt study of de-identified EPDS and PDRA data collected from a convenience sample of 585 mothers within 24 hours of delivery. We examined the prevalence of PMD risk and risk profiles for mothers reporting a difficult pregnancy or birth, a multiple birth, or a baby receiving neonatal services. Comparing the two assessments, we calculated the level of agreement of predicted PMD risk and identified items that clustered together through principal components analysis with oblique rotation. Four factors were detected: stress, emotional response, history, and self-harm. We concluded that the EPDS and PDRA are assessing different risk factors for PMD. We recommend that both assessments be used in the hospital setting to assure detection of mothers at high-risk for PMD so they can be connected with PMD resources beyond discharge.