202145 Postpartum Depression Screening: NIMH funded study

Monday, November 9, 2009: 8:50 AM

Katherine Wisner, MD MS , Psychiatry, OB/GYN, and Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
Objective: Postpartum depression screening is required in two states and the MOTHERS Act (pending in the Senate) may expand this requirement. The objective was collection of data to drive screening methodology and service development.

Methods. Screening was offered to all women who delivered at the University of Pittsburgh Magee Womens Hospital (9,000 births/year). Screening was done by phone at 4-6 weeks post-birth with the Edinburgh Postnatal Depression Screening Scale (EPDS). Mothers who scored >10 on the EPDS had an in-home psychiatric diagnostic evaluation to identify disorders associated with positive screens and clarify episode onset relative to childbearing.

Results: Positive screens were found in 13.8% of women. Home visits (N=328) have been completed and the diagnoses were: 1) Major depression, N=225 (69%); Bipolar Disorder, N=59 (18%); Anxiety Disorder, N=30 (9%); Substance Use Disorder, N=1 (0.3%); Other, N=7 (2%); No diagnosis, N=6 (2%). The onset of the identified episodes was: during pregnancy, N=90 (27%); postpartum (within 4 weeks of birth), N=121 (37%); and prior to pregnancy, N=117 (36%).

Conclusions: Although 69% of the women had major depression, a positive EPDS identified other major disorders, particularly bipolar and anxiety disorders. Post-birth screening identified a majority (63%) of women who had longer term episodes (illness onset either during pregnancy or prior to the index pregnancy). Early onset comorbidities were common: Of 328 subjects, women with anxiety disorders =172 (over half), with substance abuse/dependence=64 (nearly 20%) and women with eating disorders=31 (nearly 10%); numbers are not mutually exclusive with respect to comorbidities.

Learning Objectives:
Identify a screening process for postpartum deprsesion including rate of positive screens, diagnoses of women with postiive screens

Keywords: Maternal and Child Health, Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Full Professor with Tenure, 3 R01 grants funded currenty through NIMH, continued funding since 1988; study section service for 14 years; numerous awards, over 130 peer reviewed publications; President, Marce Society for the Study of Childbearing Related Psyciatric Disorders (International); member American College of Neuropsychiatrists and Chair, Research Subjects Commiteee; Distinguished Fellow, American Psychiatric Association; Program Chair, North American Society for Psychosocial Obstetrics and Gynecology X2
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
GSK depression Speaker's bureau and teaching engagements
Novagyne subsidiary of Novartis donation of placebo patches to match estradiol patches for an NIMH funded study
Pfizer, Inc grant awarded but cancelled by me piror to startup Independent Contractor (contracted research and clinical trials)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.