Over the last 3 years there have been notable developments in the screening and treatment of perinatal depression. Most importantly, the DSM-V has made only minor changes in the diagnostic criteria for perinatal depression as compared to the DSM-IV; “perinatal,” as opposed to “postpartum,” is a specifier for depression with a requirement that the depression onset occurs during pregnancy or the first 4 weeks postpartum. Advances in the treatment of perinatal depression have been made over the last 3 years, including both prevention and acute interventions. Additional support has emerged confirming the primary risk factors for perinatal depression: a personal or family history, low SES and poor interpersonal support. There is general agreement that universal screening be conducted for all perinatal women, by both the woman’s obstetrician and the baby’s pediatrician.
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The two-item screen “have you felt down, depressed, or hopeless” and “have you lost interest or pleasure in things” does not have well-established sensitivity and specificity metrics. It also lacks utility as a clinical screening instrument because it does not screen for infrequent but potentially life-threatening thoughts such as self-harm or thoughts of harming the baby.
The three-item Prams screen includes the items: “I have felt down, depressed, or sad,” “I have felt hopeless,” and “I have felt slowed down physically” rated on a 1-5 scale from never to always.
Please see Deligiannidis and Freeman (2014) “Complementary and alternative treatments for perinatal depression” for a detailed description of these therapies . Deligiannidis, K.M. and M.P. Freeman, Complementary and alternative medicine therapies for perinatal depression. Best Practice Research in Clinical Obstetrics and Gynaecology, 2014. 28(1): p. 85-95.
Papers of particular interest, published recently, have been highlighted as: • Of importance
Gavin NI et al. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106:1071–83.
O'Hara MW, Swain AM. Rates and risk of postpartum depression: a meta-analysis. Int Rev Psychiatry. 1996;8:37–54.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 5–25. ISBN 978-0-89042-555-8. 2013, Arlington, Virginia: American Psychiatric Publishing.
Association American Psychiatric. Diagnostic and statistical manual of mental disorders. 4th (text rev.). Washington D.C.: APA; 2000.
Gaynes BN, et al. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes, in Evidence Report/Technology Assessment No. 119, AHRQ, Editor. 2005, AHRQ: Rockville, MD.
O'Hara MW et al. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynecol. 2014;28:3–12.
Wisner KL, Moses-Kolko E, Sit D. Postpartum depression: a disorder in search of a definition. Arch Women’s Mental Health. 2010;13:37–40. According to the DSM-IV, postpartum depression is bound to time limits of onset and conclusion, which, while helpful, are incongruent with the depression presentation seen in most women following the birth of their child. Specifically, it does not make allowances for women who experience postpartum depression outside of the time range specified, nor does it allow for the onset of depression in the prenatal period. Additional considerations that are not addressed in the DSM-IV are the role of comorbid disorders, the potential need for a postpartum onset specifier for other disorders and mothers who experience depression following a miscarriage, still birth or other adverse birth outcome. Mental health as a field stands to benefit from perinatal research, as it informs outcomes in later life and other etiological factors. It therefore needs more consideration in future diagnostic work.
Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–85.
Lancaster CA et al. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010;202(1):5–14.
Koleva H et al. Risk factors for depressive symptoms during pregnancy. Arch Women’s Mental Health. 2011;14:99–106.
Rodriguez M et al. Intimate partner violence and maternal depression during the perinatal period: a longitudinal investigation of latinas. Violence Against Women. 2010;16(5):543–59.
Buttner MM et al. Examination of premenstrual symptoms as a risk factor for depression in postpartum women. Arch Women’s Mental Health. 2013;16(3):219–25.
Cox JL. J.M. Holden, and R. Sagovsky, Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.
Wang LL et al. Prevalence and risk factors of maternal depression during the first three years of child rearing. J Women's Health. 2011;20:711–8.
Murray L. The impact of postnatal depression on infant development. J Child Psychol Psychiatry. 1992;33:543–61.
Murray L, Cooper P. Effects of postnatal depression on infant development. Arch Dis Child. 1997;77(2):99–101.
Beck CT. The effects of postpartum depression on child development: a meta-analysis. Arch Psychiatr Nurs. 1998;12:12–20.
Goodman SH et al. Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev. 2011;14(1):1–27.
Field T. Prenatal depression effects on early development: a review. Infant Behav Dev. 2011;34:1–14. Traditionally, research has focused on postpartum depression and paid little attention to the importance of prenatal depression and the effect it has on infants. Prenatal depression has similar prevalence rates, although some research indicates that it occurs at a higher rate than postpartum depression; thus, it is a critical area for further research. Current studies show that prenatal depression is a good predictor of postpartum depression, is related to poorer health outcomes for the mother, may negatively alter physiological responses of the fetus, and can lead to lower birth weight and early delivery. Post-birth, infants show decreased attention to stimuli, have lower quality maternal interactions and may have more difficult temperaments, in addition to sleep disturbances. Future research should focus on risk factors for prenatal depression, better understanding why and by what mechanisms prenatal depression influences poor maternal and infant outcomes, as well as looking at additional factors such as the role of comorbid anxiety and cortisol.
Barrett J, Fleming A. Annual research review: all mothers are not created equal: neural and psychobiological perspectives on mothering and the importance of individual differences. J Child Psychol Psychiatry. 2011;52(4):368–97.
Grote NK et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24. Negative birth outcomes, such as preterm birth, low birth weight and intrauterine growth restriction, are globally the strongest predictors of early death, neurodevelopmental impairments and disabilities for infants. Prenatal depression is related to the incidence of these outcomes and, despite the small effect size found in the meta-analysis, represents a potentially significant public health problem. Low socioeconomic status, in addition to prenatal depression, represents higher risk for negative birth outcomes. Mechanisms driving this relationship include factors such as higher stress, food insecurity, lack of neighborhood safety and poor health insurance. Women should be universally screened in order to help decrease the rates of untreated prenatal depression and the serious public health problem that this disorder presents.
Skrundz M et al. Plasma oxytocin concentration is associated with development of postpartum depression. Neuropsychopharmocology. 2011;36:1886–93.
American College of Obstetrics and Gynecology. Screening for Depression During and After Pregnancy. 2010 [cited 2014 March 27, 2014]; Available from: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Screening_for_Depression_During_and_After_Pregnancy.
Earls M, The Committee on Psychological Aspects of Child and Family Health. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126:1032–9.
Georgiopoulos AM et al. Routine screening for postpartum depression. J Fam Pract. 2001;50:117–22.
Byatt N et al. Strategies for improving perinatal depression treatment in North American outpatient obstetric settings. J Psychosom Obstet Gynecol. 2012;33(4):143–61.
Miller LJ et al. Now what? Effects of on-site assessment on treatment entry after perinatal depression screening. J Women's Health. 2012;21(10):1046–52.
Yawn B et al. TRIPPD: a practice-based effectiveness study of postpartum depression screening and management. Ann Fam Med. 2012;10:320–9.
Spitzer RL et al. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol. 2000;183:759–69.
Spitzer RL, Kroenke K, Willaims JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 2000;282:1737–44.
Davis K et al. Analysis of brief screening tools for the detection of postpartum depression: Comparisons of the PRAMS 6-item instrument, PHQ-9, and structured interviews. Arch Women's Mental Health. 2013;16(4):271–7.
O'Hara MW et al. Brief scales to detect postpartum depression and anxiety symptoms. J Women's Health. 2012;21(12):1237–43.
Sidebottom A, et al. Validation of the Patient Health Questionnaire (PHQ)-9 for prenatal depression screening. Archives of Women’s Mental Health, 2012. 15(367-374).
Bergink V et al. Validation of the Edinburgh Depression Scale during pregnancy. J Psychosom Res. 2011;70:385–9.
Flynn H et al. Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services. Psychiatry Rev. 2011;187:130–4.
Tandon SD et al. A comparison of three screening tools to identify perinatal depression among low-income African American women. J Affect Disord. 2012;136:155–62.
Beck AT et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.
Radloff LS. The CES-D scale: a new self-report depression scale for research in the general population. Applied Psychol Measurement. 1977;1:385–401.
Milgrom J, Mendelsohn M, Gemmill A. Does postnatal depression screening work? Throwing out the bathwater, keeping the baby. J Affect Disord. 2011;132:301–10.
Grote NK et al. A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatr Serv. 2009;60(3):313–21.
Stuart S, Robertson M. Interpersonal Psychotherapy: A Clinician's Guide. 2nd ed. London: Oxford University Press; 2012.
Roman LA et al. Alleviating perinatal depressive symptoms and stress: a nurse-community health worker randomized trial. Arch Womens Mental Health. 2009;12:379–91.
Field T et al. Yoga and massage therapy reduce prenatal depression and prematurity. J Bodyw Mov Ther. 2012;16(2):204–9.
Freeman MP, Davis MF. Supportive psychotherapy for perinatal depression: preliminary data for adherence and response. Depression Anxiety. 2010;27(1):39–45.
Deligiannidis KM, Freeman MP. Complementary and alternative medicine therapies for perinatal depression. Best Practice Res Clin Obstet and Gynaecol. 2014;28(1):85–95.
Manber R et al. Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol. 2010;115(3):511–20.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.
Wirz-Justice A et al. A randomized double-blind, placebo controlled study of light therapy for antepartum depression. J Clin Psychiatry. 2011;72(7):986–93.
Parry B et al. Early versus late wake therapy effects on mood and sleep in pregnancy and postpartum depression. J Sleep Res. 2010;19:272.
Stuart S, Koleva H. Psychological treatments for perinatal depression. Best Pract Res Clin Obstet Gynaecol. 2014;28:61–70. Treatments that are currently validated and effective for perinatal depression are interpersonal psychotherapy and cognitive behavioral therapy. In addition, therapies that have been adapted specifically for the perinatal population and are manual based tend to be most effective. Although many women may prefer not to be treated with medication in the perinatal period, medication can be combined with psychotherapy to effectively treat perinatal depression. In some cases, medication might even be critical as untreated depression has the potential to be more detrimental than the effects of medication. Research is also beginning to show that phone- and Internet-based treatments are effective and feasible treatments for perinatal depression, although more research is needed in these areas. Future studies should also address further information on medication, comparisons of different therapies and increased methodological rigor, specifically larger sample sizes and more sample diversity.
Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev. 2013. doi:10.1002/14651858.CD001134.pub3. The Cochrane Reviews are evidence-based reviews representing the gold standard for health care. The review on psychosocial and psychological treatments for postpartum depression prevention indicate that several beneficial treatments currently exist, including interpersonal psychotherapy, professionally based home visits and phone support. Additionally, when instituted in the postpartum period, these interventions effectively reduced women’s risk of developing postpartum depression, as did identifying women who were specifically “at risk.” While the studies included in this review included a large sample size and indicate promising results, additional research is still needed in order to better understand and improve preventive measures for postpartum depression.
Brugha TS et al. Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care. Psychol Med. 2011;41(4):739–48.
Ho SM et al. Effectiveness of a discharge education program in reducing the severity of postpartum depression. A randomized controlled evaluation study. Patient Educ Couns. 2009;77(1):68–71.
Gao LL, Chan SW, Sun K. Effects of an interpersonal-psychotherapy-oriented childbirth education programme for Chinese first-time childbearing women at 3-month follow up: randomised controlled trial. Int J Nurs Stud. 2012;49(3):274–81.
Tandon SD et al. Preventing perinatal depression in low-income home visiting clients: A randomized controlled trial. J Consult Clin Psychol. 2011;79(5):707–12.
Surkan PJ et al. Impact of a health promotion intervention on maternal depressive symptoms at 15 months postpartum. Matern Child Health J. 2012;16(1):139–48.
Lara MA, Navarro C, Navarrete L. Outcome results of a psycho-educational intervention in pregnancy to prevent PPD: a randomized control trial. J Affect Disord. 2010;122:109–17.
Cupples ME et al. A RCT of peer-mentoring for first-time mothers in socially disadvantaged areas (the MOMENTS Study). Arch Dis Child. 2011;96(3):252–8.
Tripathy P et al. Effect of a participatory intervention with women’s groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial. Lancet. 2010;375:1182–92.
Howell EA et al. Reducing postpartum depressive symptoms among black and latina mothers: a randomized controlled trial. Obstet Gynecol. 2012;119(5):942–9.
Le HN, Perry DF, Stuart EA. Randomized controlled trial of a preventive intervention for perinatal depression in high risk Latinas. J Consult Clin Psychol. 2011;79(2):135–41.
Milgrom J et al. Towards parenthood: an antenatal intervention to reduce depression, anxiety and parenting difficulties. J Affect Disord. 2011;130(3):385–94.
Silverstein M et al. Problem-solving education to prevent depression among low-income mothers of preterm infants: a randomized controlled pilot trial. Arch of Women’s Mental Health. 2011;14(4):317–24.
Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev. 2011;31:839–49.
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of Depression. New York: Guilford Press; 1979.
Bledsoe S, Grote N. Treating depression during pregnancy and the postpartum: a preliminary meta-analysis. Res Social Work Pract. 2006;16:109–20.
Dennis CL, Hodnett E. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Systematic Review, 2007. 4(CD006116).
Cuijpers P, Brannmark JG, van Straten A. Psychological treatment of postpartum depression: a meta-analysis. J Clin Psychiatry. 2008;64(1):103–18.
Morrell C et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. Br Med J (Clin Res Edition). 2009;338:a3045.
Mulcahy R et al. A randomised control trial for the effectiveness of group interpersonal psychotherapy for postnatal depression. Arch Women's Mental Health. 2010;13(2):125–39.
Sheeber L et al. Development and pilot evaluation of an Internet-Facilitated Cognitive-Behavioral Intervention for maternal depression. J Consult Clin Psychol. 2012;80(5):739–49.
O’Mahen H et al. A pilot randomized controlled trial Of behavioral therapy for perinatal depression adapted for women with low incomes. Depression Anxiety. 2013;30:679–87.
O’Mahen H et al. Internet-based behavioral activation – treatment for postnatal depression (Netmums): a randomized control trial. J Affect Disord. 2013;150:814–22.
Crowley S, Youngstedt S. Efficacy of light therapy for perinatal depression: a review. J Physiol Anthropol. 2012;31(15):1–7.
Borja-Hart NL, Marino J. Role of omega-3 fatty acids for prevention or treatment of perinatal depression. Pharmacotherapy. 2010;30(2):210–6.
Jans LAW, Giltay EJ, Van der Does AJW. The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression. Br J Nutr. 2010;104:1577–85.
Hantsoo L et al. A randomized placebo-controlled, double-blind trial of sertaline for postpartum depression. Psychopharmacology. 2014;231:939–48.
Bloch M et al. The effect of sertraline add-on to brief dynamic psychotherapy for the treatment of postpartum depression: a randomized, doubleblind, placebo-controlled study. J Clin Psychiatry. 2012;73:235–41.
Davalos D, Yadon C, Tregallas H. Untreated prenatal maternal depression and the potential risks to offspring: a review. Arch Women’s Mental Health. 2012;5:1–14.
Udechuku A et al. Antidepressants in pregnancy: a systematic review. Aust N Z J Psychiatry. 2010;44:978–96.
Ng RC, Hirata CK, Yeung W. Pharmacologic treatment for postpartum depression: a systematic review. Pharmacotherapy. 2010;30(9):928–41.
di Scalea TL, Wisner KL. Pharmacotherapy of postpartum depression. Expert Opin Pharmacotherapy. 2009;10(16):2593–607.
Gentile S, Galbally M. Prenatal exposure to antidepressant medications and neurodevelopmental outcomes: A systematic review. J Affect Disord. 2011;128:1–9.
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Kaela Stuart-Parrigon declares no conflict of interest.
Scott Stuart has received a grant from the National Institute of Heath.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Psychiatry in Primary Care
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Stuart-Parrigon, K., Stuart, S. Perinatal Depression: An Update and Overview. Curr Psychiatry Rep 16, 468 (2014). https://doi.org/10.1007/s11920-014-0468-6