Guideline 9

Perinatal mood disorders, which include major and minor depressive episodes and anxiety that occur during pregnancy or in the first 12 months after the end of pregnancy, are one of the most common medical complications during pregnancy and the postpartum period, affecting one in five mothers and one in ten fathers (2). It is important to identify pregnant and postpartum clients with mood disorders because untreated perinatal mood disorders can have devastating effects on the parent, as well as their infants and families. Likewise, depression outside of the perinatal period can have a major impact on a child's life. Depressed caregivers may use less emotion or expression when communicating with infants and adversely impact bonding. Depressed parents are more likely to have challenges meeting the health and safety needs of their children (3). 

Use a validated tool to screen all clients for depression and anxiety. Examples of validated tools are below. 
Patient Health Questionnaire-9 (PHQ-9) 9-item screener for DSM-IV depression criteria and other leading major depressive symptoms, especially valuable outside of the perinatal period. (Utilized by Nurse-Family Partnership program) 

Edinburgh Postnatal Depression Scale (EPDS) 10- item non-standardized self-report measure assessing maternal postnatal/postpartum depression. (Utilized by Family Connects Oregon program) 
GAD7 – A 7 item self-reported questionnaire to assess the severity of generalized anxiety disorder symptoms over the last two weeks.

Both the EPDS and the PHQ-9 are validated for use in the perinatal population, and there is no fee. The benefits are that they are self-administered, translated into many languages, and easy to complete. The EPDS addresses the anxiety component of perinatal mood disorders as well as depressive symptoms and suicidal thoughts. The PHQ-9 does not have the anxiety component but includes suicidal ideation; it is also validated outside of the perinatal period. 

The screens should be administered at intervals according to the guidelines of the home visiting program and any time concerns arise. Communicate screening results to prenatal care provider if not within normal limits and document. Determine need for further assessment. 

If the screening results suggest a mood disorder, share concerns with the client and develop a plan of care to: 

• Continue to establish a supportive relationship 
  
• Recognize and reassure. They are not alone, it is not their fault, and with help they will get better 
• Help the client obtain support from a provider, support groups, friends or family.
• Educate on possible treatment and support options. 
• Plan interventions based on need (e.g., safety plans, Lines for Life) 

References

1. Oregon Maternal Mental Health Webpage https://www.oregon.gov/oha/PH/HEALTHYPEOPLEFAMILIES/WOMEN/ MATERNALMENTALHEALT H/pages/index.aspx 
   
2. Postpartum Support International https://www.postpartum.net/ 

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