Wednesday, May 01, 2013

A simple two question tool to reliably indicate Post Partum Depression

Postpartum Depression (PPD) (also known as postnatal depression) is a largely overlooked health problem in India, due to lack of awareness and to a stigma of mental illness. In a recent mdCurrent-India survey, 70% of doctors delivering 5 or more babies a week did not always screen for post-partum depression. PPD is a health condition that should not be ignored, as it affects not only the mother, but also the short- and long-term growth and health of the child. Depressed mothers are less able to take care of themselves and provide proper care or nourishment for their infant, which can even lead to increased maternal and infant mortality. The number of deaths and adverse effects on families in India can be reduced by early intervention and prevention by obstetricians and primary care physicians (PCP). The PCP is usually the first doctor to see the mother and infant after birth, and has the advantage of continuity and building a long-term doctor-patient relationship with the patient and family.

PPD diagnostic tools
A well-established screening tool for PPD in India is the Edinburgh Postnatal Depression Scale (EPDS) or a Hindi-translated version of the structured questionnaire. The Kessler-10 item scale is also an established questionnaire for detecting common mental illness in a community setting, and has been used in India and World Mental Health Surveys. The Two-Question Test on depressed mood is a short screening tool with a high sensitivity that may be an effective screening tool for doctors who have time constraints . The following questions are asked in the Two-Question Test:
  1. “During the past month, have you often been bothered by feeling down, depressed or hopeless?”
  2. “During the past month, have you often been bothered by little interest or pleasure in doing things?”
If the patient answers “no” to both questions, then depression is highly unlikely. If a patient answers “yes” to either question, then other symptoms of depression should be detected before confirming the diagnosis of postpartum depression.
For a formal assessment you can look at these resources...
Physician resources – screening tools:

Edinburgh Postnatal Depression Scale (EPDS) with scoring instructions (
Kessler Psychological Distress Scale (K10)
  Self-administered questionnaire (
  Interviewer-administered questionnaire (
Comment: Even though I am a pediatrician, I do see many mothers who appear to be having at least some symptoms of PPD. These two questions should help me at do a basic screen to help identify those at risk for this problem which may adversely affect the development of the child too.

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