Psychosocial Assessment and Depression Screening in the Perinatal Period: Benefits, Challenges and Implementation

  • Marie-Paule AustinEmail author
  • Dawn Kingston


Primary prevention and early intervention have the potential to be very powerful approaches perinatally, because of the frequent contacts that women have with health services at this time and the significant morbidity associated with untreated maternal mental health conditions, not only for mother but also infant and family. Implicit in this public health approach is the use of screening tools and programmes, with all the challenges that they bring. Early identification and treatment of psychosocial morbidity are especially important in relation to the functioning of the family unit and the critical parent-infant relationship with potential to positively impact on the health of the next generation.


Intimate Partner Violence Postpartum Depression Postnatal Depression Depression Screening Perinatal Depression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn, (text rev.), Washington, DC, American Psychiatric AssociationGoogle Scholar
  2. Austin M-P (2004) Antenatal screening and early intervention for ‘perinatal’ distress, depression and anxiety: where to from here? Arch Womens Ment Health 7:1–6CrossRefPubMedGoogle Scholar
  3. Austin M-P, Hadzi-Pavlovic D, Priest SR et al (2010) Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Arch Womens Ment Health 13:395–401Google Scholar
  4. Austin M-P, Hadzi-Pavlovic D, Saint K et al (2005) Antenatal screening for the prediction of postnatal depression: validation of a psychosocial Pregnancy Risk Questionnaire. Acta Psychiatr Scand 112:310–317CrossRefPubMedGoogle Scholar
  5. Austin M-P, Highet N and the Guidelines Expert Advisory Committee (2011) Clinical practice guidelines for depression andrelated disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. beyondblue: the national depression initiative, MelbourneGoogle Scholar
  6. Austin M-P, Marcé Society Position Statement Advisory Committee (2014) Marce International Society position statement on psychosocial assessment and depression screening in perinatal women. Best Pract Res Clin Obstet Gynaecol 28:179–187Google Scholar
  7. Austin M-P, Middleton P, Reilly NM et al (2013a) Detection and management of mood disorders in the maternity setting: the Australian Clinical Practice Guidelines. Women Birth J Aust Coll Midwives 26:2–9CrossRefGoogle Scholar
  8. Austin M-P, Colton J, Priest S et al (2013b) The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting. Women Birth 26:17–25Google Scholar
  9. Bales M, Pambrun E, Melchior M et al (2015) Prenatal psychological distress and access to mental health care in the ELFE cohort. Eur Psychiatry 30:322–328CrossRefPubMedGoogle Scholar
  10. Bauer A, Pawlby S, Plant DT et al (2015) Perinatal depression and child development: exploring the economic consequences from a South London cohort. Psychol Med 45:51–61CrossRefPubMedGoogle Scholar
  11. Beckwith L, Howard J, Espinosa M et al (1999) Psychopathology, mother-child interaction, and infant development: substance-abusing mothers and their offspring. Dev Psychopathol 11:715–725CrossRefPubMedGoogle Scholar
  12. Bowen A, Bowen R, Butt P et al (2012) Patterns of depression and treatment in pregnant and postpartum women. Can J Psychiatry 57:161–167PubMedGoogle Scholar
  13. Buist A, Condon J, Brooks J et al (2006) Acceptability of routine screening for perinatal depression. J Affect Disord 93:233–237Google Scholar
  14. Byatt N, Simas TAM, Lunddquist RS et al (2012) Strategies for improving perinatal depression treatment in North American outpatient obstetric settings. J Psychosom Obstet Gynecol 33:143–161CrossRefGoogle Scholar
  15. Campbell S, Norris S, Standfield L et al (2008) Screening for postnatal depression within the Well Child Tamariki Ora Framework. HSAC Report 2(1) University of Canterbury, ChristchurchGoogle Scholar
  16. Canadian Task Force on Preventive Health Care; Joffres M, Jaramillo A, Dickinson J et al (2013) Recommendations on screening for depression in adults. CMAJ Can Med Assoc J 185:775–782Google Scholar
  17. Cao-Lei L, Massart R, Suderman MJ et al (2014) DNA methylation signatures triggered by prenatal maternal stress exposure to a natural disaster: Project Ice Storm. PLoS One 9, e107653Google Scholar
  18. Carroll JC, Reid AJ, Biringer A et al (2005) Effectiveness of the Antenatal Psychosocial Health Assessment (ALPHA) form in detecting psychosocial concerns: a randomized controlled trial. CMAJ 173:253–259Google Scholar
  19. Carroll AE, Biondich P, Anand V et al (2013) A randomized controlled trial of screening for maternal depression with a clinical decision support system. J Am Med Inform Assoc 20:311–316Google Scholar
  20. Chaudron LH, Wisner KL (2014) Perinatal depression screening: let’s not throw the baby out with the bath water! J Psychosom Res 76(6):489–491CrossRefPubMedGoogle Scholar
  21. Chew-Graham C, Chamberlain E, Turner K et al (2008) GPs’ and health visitors’ views on the diagnosis and management of postnatal depression: a qualitative study. Br J Gen Pract 58:169–176PubMedCentralCrossRefPubMedGoogle Scholar
  22. Chew-Graham CA, Sharp D, Chamberlain E et al (2009) Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study. BMC Fam Pract 10:7Google Scholar
  23. Christl B, Reilly N, Yin C et al (2015) Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit. Arch Women Ment Health (in press)Google Scholar
  24. Coates AO, Schaefer CA, Alexander JL (2004) Detection of postpartum depression and anxiety in a large health plan. J Behav Health Serv Res 31:117–133CrossRefPubMedGoogle Scholar
  25. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786CrossRefPubMedGoogle Scholar
  26. Davalos DB, Yadon CA, Tregellas HC (2012) Untreated prenatal maternal depression and the potential risks to offspring: a review. Arch Womens Ment Health 15:1–14CrossRefPubMedGoogle Scholar
  27. Dayan J, Creveuil C, Marks MN et al (2006) Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care. Psychosom Med 68:938–946Google Scholar
  28. Dennis CL (2006) Intensive postpartum support for postnatal depression has the most beneficial outcome – meta-analysis. Evid Based Obstet Gynecol 8:94–95CrossRefGoogle Scholar
  29. Dennis CL, Hodnett E (2007) Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev (4):CD006116Google Scholar
  30. Dennis CL, Hodnett E, Kenton L et al (2009) Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ 338:a3064Google Scholar
  31. Department of Health and Ageing (2010) National perinatal depression initiative [online]. Accessed 8 May 2012
  32. Desmarais SL, Prtichard A, Lowder EM et al (2014) Intimate partner abuse before and during pregnancy as risk factors for postpartum mental health problems. BMC Pregnancy Childbirth 14:132PubMedCentralCrossRefPubMedGoogle Scholar
  33. Dunkel Schetter C, Tanner L (2012) Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry 25:141–148PubMedCentralCrossRefPubMedGoogle Scholar
  34. Fisher J, Chatham E, Haseler S (2012) Uneven implementation of the National Perinatal Depression Initiative: findings from a survey of Australian women’s hospitals. Aust N Z J Obstet Gynaecol 52:559–564CrossRefPubMedGoogle Scholar
  35. Flynn HA, Henshaw E, O’Mahen H et al (2010) Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study. Gen Hosp Psychiatry 32:9–16PubMedCentralCrossRefPubMedGoogle Scholar
  36. Gavin NI, Gaynes BN, Lohr KN et al (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083Google Scholar
  37. Gemmill AW (2014) The long gestation of screening programmes for perinatal depressive disorders. J Psychosom Res 77:242–243CrossRefPubMedGoogle Scholar
  38. Gemmill AW, Leigh B, Ericksen J et al (2006) A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women. BMC Public Health 6:211Google Scholar
  39. Giallo R, Woolhouse H, Gartland D et al (2015) The emotional-behavioural functioning of children exposed to maternal depressive symptoms across pregnancy and early childhood: a prospective Australian pregnancy cohort study. Eur Child Adolesc PsychiatryGoogle Scholar
  40. Gilbody S, Bower P, Fletcher J et al (2006) Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Inter Med 166(21):2314–2321Google Scholar
  41. Glover V (2014) Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol 28:25–35CrossRefPubMedGoogle Scholar
  42. Grant KA, McMahon C, Austin MP (2008) Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord 108:101–111CrossRefPubMedGoogle Scholar
  43. Griffiths KM, Farrer L, Christensen H (2010) The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Med J Aust 192:S4–S11PubMedGoogle Scholar
  44. Gross R, Brammli-Greenberg S, Tabenkin H (2007) Primary care physicians’ discussion of emotional distress and patient satisfaction. Int J Psychiatry Med 37:331–335CrossRefPubMedGoogle Scholar
  45. Grote NK, Bridge JA, Gavin AR et al (2010) A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine birth restriction. Arch Gen Psychiatry 67:1012–1024Google Scholar
  46. Hill C (2010) An evaluation of screening for postnatal depression against NSC criteria. UK National Screening Committee, LondonGoogle Scholar
  47. Horwitz SM, Briggs-Gowan MJ, Storfer-Isser A et al (2009) Persistence of maternal depressive symptoms throughout the early years of childhood. J Womens Health (Larchmt) 18:637–645Google Scholar
  48. Howard LM, Oram S, Galley H et al (2013) Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Med 10:e1001452Google Scholar
  49. Johnson M, Schmeid V, Lupton SJ et al (2012) Measuring perinatal mental health risk. Arch Womens Ment Health 15:375–386Google Scholar
  50. Jones I, Chandra PS, Dazzan P et al (2014) Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 384:1789–1799Google Scholar
  51. Kim JJ, La Porte LM, Corcoran M et al (2010) Barriers to mental health treatment among obstetric patients at risk for depression. Am J Obstet Gynecol 202:312.e1–312.e5Google Scholar
  52. Kingston D, Heaman M, Fell D et al (2012a) Factors associated with perceived stress and stressful life events in pregnant women: findings from a Canadian Maternity Experiences Survey. Matern Child Health J 16:158–168Google Scholar
  53. Kingston D, Tough S, Whitfield H (2012b) Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev 43:683–714CrossRefPubMedGoogle Scholar
  54. Kingston D, Tough S (2014) Prenatal and postnatal maternal mental health and school-age child development: a systematic review. Matern Child Health J 18:1728–1741CrossRefPubMedGoogle Scholar
  55. Kingston D, Austin MP, Hegadoren K et al (2014a) Study protocol for a randomized, controlled, superiority trial comparing the clinical- and cost-effectiveness of integrated online mental health assessment-referral-care in pregnancy to usual prenatal care on prenatal and postnatal mental health and infant health and development: the Integrated Maternal Psychosocial Assessment to Care Trial (IMPACT). BMC Trials 15:72Google Scholar
  56. Kingston D, McDonald S, Austin MP et al (2014b) The public’s views of mental health in pregnant and postpartum women: a population-based study. BMC Pregnancy Childbirth 14:84PubMedCentralCrossRefPubMedGoogle Scholar
  57. Kingston D, Janes-Kelley S, Tyrell J et al (2015a) An integrated web-based mental health intervention of assessment-referral-care to reduce stress, anxiety, and depression in hospitalized pregnant women with medically high-risk pregnancies: a feasibility study protocol of hospital-based implementation. JMIR Res Protoc 4:e9Google Scholar
  58. Kingston D, Biringer A, McDonald S et al (2015b) Preferences of screening among pregnant women: a cross-sectional study. Am J Prev Med (in press)Google Scholar
  59. Korhonen M, Luoma I, Salmelin R et al (2012) A longitudinal study of maternal prenatal, postnatal and concurrent depressive symptoms and adolescent well-being. J Affect Disord 136:680–692CrossRefPubMedGoogle Scholar
  60. Korhonen M, Luoma I, Salmelin R et al (2014) Maternal depressive symptoms: associations with adolescents’ internalizing and externalizing problems and social competence. Nord J Psychiatry 68:323–332Google Scholar
  61. Leiferman JA, Dauber SE, Heisler K et al (2008) Primary care physicians’ beliefs and practices toward maternal depression. J Womens Health (Larchmt) 17:1143–1150CrossRefGoogle Scholar
  62. Leung SS, Leung C, Lam TH et al (2011) Outcome of a postnatal depression screening programme using the Edinburgh Postnatal Depression Scale: a randomized controlled trial. J Public Health (Oxf) 33:292–301Google Scholar
  63. Mann R, Adamson J, Gilbody S (2012) Diagnostic accuracy of case-finding questions to identify perinatal depression. CMAJ Can Med Assoc J 184:E424–E430CrossRefGoogle Scholar
  64. Marcus SM, Flynn HA, Blow FC et al (2003) Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health (Larchmt) 12:373–380CrossRefGoogle Scholar
  65. Matthey S, Ross-Hamid C (2012) Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress. J Affect Disord 141:213–221CrossRefPubMedGoogle Scholar
  66. Matthey S, White T, Phillips J et al (2005) Acceptability of routine antenatal psychosocial assessments to women from English and non-English speaking backgrounds. Arch Womens Ment Health 8:171–180CrossRefPubMedGoogle Scholar
  67. Midmer D, Bryanton J, Brown R (2004) Assessing antenatal psychosocial health: randomized controlled trial of two versions of the ALPHA form. Can Fam Physician 50:80–87PubMedCentralPubMedGoogle Scholar
  68. Milgrom J, Gemmill A (2014) Feasibility and efficacy of an internet treatment for postnatal depression utilising a behavioural activation approach. Evid Based Nurs 17(4):102CrossRefPubMedGoogle Scholar
  69. Milgrom J, Gemmill A, Bilstza JL et al (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108:147–157CrossRefPubMedGoogle Scholar
  70. Milgrom J, Mendelsohn J, Gemmill AW (2011) Does postnatal depression screening work? Throwing out the bathwater, keeping the baby. J Affect Disord 132:301–310CrossRefPubMedGoogle Scholar
  71. Miller L, Shade M, Vasireddy V (2009) Beyond screening: assessment of perinatal depression in a perinatal care setting. Arch Womens Ment Health 12:329–334CrossRefPubMedGoogle Scholar
  72. Mitchell AJ, Coyne J (2009) Screening for postnatal depression: barriers to success. BJOG 116:11–14CrossRefPubMedGoogle Scholar
  73. Mitchell AJ, Rao S, Vaze A (2011) Can general practitioners identify people with distress and mild depression? A meta-analysis of clinical accuracy. J Affect Disord 130:26–36CrossRefPubMedGoogle Scholar
  74. Morrell C, Warner R, Slade P et al (2009) Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial. Health Technol Assess 13:1–176Google Scholar
  75. Mrazek PJ, Haggerty RJ (1994) Reducing risks for mental disorders: frontiers for preventive intervention research. The National Academies Press, Washington, DCGoogle Scholar
  76. Murray L, Carothers AD (1990) The validation of the Edinburgh Postnatal Depression Scale on a community sample. Br J Psychiatry 157:288–290CrossRefPubMedGoogle Scholar
  77. Murray L, Arteche A, Fearon P et al (2010) The effects of maternal postnatal depression and child sex on academic performance at age 16 years: a developmental approach. J Child Psychol Psychiatry 51:1150–1159Google Scholar
  78. Murray L, Arteche A, Fearon P et al (2011) Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J Am Acad Child Adolesc Psychiatry 50:460–470Google Scholar
  79. Myers ER, Aubuchon-Endlsey N, Bastian LA et al (2013) Efficacy and safety of screening for postpartum depression. Comparative effectiveness review 106. AHRQ Publication No. 13-EHC064-EF. Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
  80. National Institute for Health and Clinical Excellence (2014) Antenatal and postnatal mental health: clinical management and service guidance, updated edition, Clinical Guidance 192. National Collaborating Centre for Mental Health, LondonGoogle Scholar
  81. O’Donnell KJ, Glover V, Barker ED et al (2014) The persisting effect of maternal mood in pregnancy on childhood psychopathology. Dev Psychopathol 26:393–403CrossRefPubMedGoogle Scholar
  82. O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression: a meta-analysis. Int Rev Psychiatry 8:37–54CrossRefGoogle Scholar
  83. Oberlander TF, Warburton W, Misri S et al (2006) Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry 63:898–906Google Scholar
  84. Paulden M, Palmer S, Hewitt S et al (2009) Screening for postnatal depression in primary care: cost effectiveness analysis. BMJ 339:b5203Google Scholar
  85. Post and Antenatal Depression Association (2012) The cost of perinatal depression in Australia. Final report (executive summary). Deloitte Access Economics, MelbourneGoogle Scholar
  86. Priest SR, Barnett B (2008) Perinatal depression and anxiety: issues, outcomes and interventions. In: Sved-Williams A, Cowling V (eds) Infants of parents with mental illness. Australian Academic Press, Bowen HillsGoogle Scholar
  87. Priest SR, Austin MP, Barnett BB et al (2008) A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings. Arch Womens Ment Health 11:307–317CrossRefPubMedGoogle Scholar
  88. Reay R, Matthey S, Ellwood D et al (2011) Long-term outcomes of participants in a perinatal depression early detection program. J Affect Disord 129:94–103CrossRefPubMedGoogle Scholar
  89. Reid AJ, Biringer A, Carroll JD et al (1998) Using the ALPHA form in practice to assess antenatal psychosocial health. Antenatal Psychosocial Health Assessment. CMAJ 159:677–684Google Scholar
  90. Reilly N, Harris S, Loxton D et al (2013a) Disparities in reported psychosocial assessment across public and private maternity settings: a national survey of women in Australia. BMC Public Health 13:1–15Google Scholar
  91. Reilly N, Harris S, Loxton D et al (2013b) Referral for management of emotional health issues during the perinatal period: does mental health assessment make a difference? Birth 40:297–306Google Scholar
  92. Reilly N, Harris S, Loxton D et al (2014) The impact of routine assessment of past or current mental health on help-seeking in the perinatal period. Women Birth 27:e20–e27Google Scholar
  93. Reilly N, Yin C, Monterosso L et al (2015) Identifying psychosocial risk of mothers in an Australian private maternity setting: a pilot study. ANZJOG (in press)Google Scholar
  94. Robertson E, Grace S, Wallongton T et al (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26:289–295Google Scholar
  95. Silverman M, Loudon H (2010) Antenatal reports of pre-pregnancy abuse is associated with symptoms of depression in the postpartum period. Arch Womens Ment Health 13:411–415CrossRefPubMedGoogle Scholar
  96. Spitztler RL, Wolliams JB, Kroenke K et al (2000) 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 183:759–769Google Scholar
  97. Sword W, Busser D, Ganann R et al (2008) Women’s care-seeking experiences after referral for postpartum depression. Qual Health Res 18:1161–1173CrossRefPubMedGoogle Scholar
  98. Talge NM, Neal C, Glover V (2007) Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? J Child Psychol Psychiatry 48:245–261Google Scholar
  99. Thombs BD, Arthurs E, Coronado-Montoya S et al (2014) Depression screening and patient outcomes in pregnancy or postpartum: a systematic review. J Psychosom Res 76:433–446CrossRefPubMedGoogle Scholar
  100. UK National Screening Committee (2009) Criteria for appraising the viability, effectiveness and appropriateness of a screening program. National Health Service, SouthamptonGoogle Scholar
  101. Vythilingum B, Field S, Kafaar Z et al (2013) Screening and pathways to maternal mental health care in a South African antenatal setting. Arch Womens Ment Health 16:371–379CrossRefPubMedGoogle Scholar
  102. Whooley MA, Avins AL, Miranda J et al (1997) Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 12:439–445Google Scholar
  103. Wisner KL, Sit DK, McShea MC et al (2013) Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 70:490–498PubMedCentralCrossRefPubMedGoogle Scholar
  104. Woolhouse H, Brown S, Krastev A et al (2009) Seeking help for anxiety and depression after childbirth: results of the Maternal Health Study. Archives Women Ment Health 12:75–83CrossRefGoogle Scholar
  105. Woolhouse H, Gartland D, Mensah F et al (2015) Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG Int J ObstetGynaecol 122(3):312–21CrossRefGoogle Scholar
  106. Yawn BP, Dietrich AJ, Wollan P et al (2012) TRIPPD: a practice-based network effectiveness study of postpartum depression screening and management. Ann Fam Med 10:320–329PubMedCentralCrossRefPubMedGoogle Scholar
  107. Zelkowitz P, Gold I, Feeley N et al (2014) Psychosocial stress moderates the relationships between oxytocin, perinatal depression, and maternal behavior. Horm Behav 66:351–360Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Perinatal and Women’s Mental Health Unit (PWMHU)St John of God HospitalBurwoodAustralia
  2. 2.The Black Dog Institute, University of New South WalesRandwickAustralia
  3. 3.Faculty of Nursing, Faculty of Medicine, Department of Obstetrics and Gynecology5-258 Edmonton Clinic Health Academy, University of AlbertaEdmontonCanada

Personalised recommendations