Identifying Postpartum Depression and Comorbid Psychiatric Disorders

Monday, 18 November 2013: 10:20 AM

June Andrews Horowitz, RN, PhD, PMHCNS-BC, FAAN1
Joanne Doller Wojcik, Phd, PMHCNS-BC2
Christine Murphy, PhD, RN3
Katherine E. Gregory, RN, PhD1
Lori Solon, MSN, PMH, CNS-BC4
(1)William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
(2)William F. Connell School of Nursing, Commonwealth Research Center, Boston, MA 02115, MA
(3)Boston College, Chestnut Hill, MA, MA
(4)Wm/ F. Connell School of Nursing, Boston College, Chestnut Hill, MA

Learning Objective 1: 1. Identify conditions that are likely to be comorbid with postpartum depression (PPD)

Learning Objective 2: 2. Examine approaches to PPD screening and diagnosis, and identification of comorbid conditions

Purpose: Postpartum depression (PPD) prevalence is 10-15% yet PPD often goes undetected. Comorbid mental health disorders are even less likely to be identified and treated. The purpose of this presentation is to examine prevalence of comorbid conditions among a sample of postpartum women with PPD; and to describe techniques for screening and diagnostic confirmation.  

Methods: In the CARE study (Communicating And Relating Effectively, R01 NR08033) scores on the Edinburgh Postnatal Depression Scale (EPDS) identified postpartum women who were at-risk for PPD. To confirm PPD diagnostic status, advanced practice psychiatric nurses (APRNs) conducted standard diagnostic interviews to determine depression and presence of comorbid Axis I disorders.

Results: PPD was diagnosed for 134 women as: Major Depressive Disorder (76.9%), Minor Depressive Disorder (16.4%) and Depression NOS (6.7%). Many (27.6%) of these women met criteria for an anxiety disorder including generalized anxiety disorder, panic disorder, phobia, PTSD, bulimia and OCD. A past history of depression was found in 49.3% of the women and 60.4% had a past Axis I disorder. The women with a current comorbid anxiety disorder were more likely to have a higher EPDS score (> 13) (62.2%, p = .02) than others with a positive EPDS screen. Notably there was no difference in EPDS scores for those with and without a past history of depression, anxiety or a substance use disorder.


Conclusions and Implications: Results showed that PPD screening is a viable approach to identify women who are at-risk for depression along with comorbid mental health disorders. Standardized interviews following screening can validate PPD symptom severity and identify other current and past Axis I disorders to be addressed in planning treatment needs. Thus universal PPD screening followed by selective diagnostic interviews is proposed as an effective and efficient approach for identifying PPD and comorbid conditions.