Every year, more than 6,500 women give birth at Cedars-Sinai Medical Center. Now, all new mothers are being screened for one of the most under-diagnosed and under-treated medical conditions in women: postpartum depression.
According to the Centers for Disease Control and Prevention, 11 percent of women who give birth each year report symptoms of postpartum depression. Only a small number ever get help, leaving many with the serious, untreated condition.
“Postpartum depression not only impacts the mother, but also her whole family,” says Sarah J. Kilpatrick, MD, PhD, chair of the Cedars-Sinai Department of Obstetrics and Gynecology. “It is extremely important we try to identify depression and then offer interventions to support the mother and her family.”
The new Postpartum Depression Screening, Education and Referral Program at Cedars-Sinai aims to address this problem in a comprehensive way. The program reflects a growing consensus among healthcare providers about the importance of diagnosing and treating this condition in new mothers. It builds on another Cedars-Sinai effort, started in 2014, to screen all admitted patients for depression.
Through the program, nurses evaluate new mothers for postpartum depression one or two days after giving birth but before the women leave the hospital. The evaluation includes having patients answer the nine-item Patient Health Questionnaire, considered a reliable and effective clinical tool for measuring symptoms of depression.
New mothers are asked a range of questions, including whether they are feeling down, depressed or hopeless. Other questions are designed to gauge a woman’s self-esteem after childbirth, asking if she feels bad about herself, feels like a failure or if she thinks she is letting her family down in any way.
If the screening does not reveal any persistent symptoms of postpartum depression, women still are offered a pamphlet with guidance and resources in case they encounter problems after leaving the hospital. For new mothers showing signs of moderate-to-severe depression, the program offers referrals for interventions that can include talk therapy, support groups, medication and lifestyle changes to improve sleep, exercise and diet.
“If they want to consult a psychiatric social worker while at the hospital, we can arrange it,” says Eynav Accortt, PhD, an assistant professor in the Department of Obstetrics and Gynecology, and a clinical psychologist. “If a new mom is reluctant to seek help, our nurse can make sure the woman’s personal obstetrician is made aware of concerns we have about the risk for postpartum depression and suggest that the doctor discuss this during the first postpartum visit or sooner.”
Postpartum depression involves more than just new mothers feeling tired or overwhelmed for a short time — symptoms include feelings of prolonged sadness, irritability or anger, disruptions in eating and sleeping habits, or a mother’s inability to take care of her new baby or herself. These symptoms can persist for weeks or months. Additional challenges to diagnosing and treating the illness come from stigma and shame women can feel if they are unable to cope after giving birth, experts explain.
“So many women are suffering silently,” Accortt said. “If we can routinely screen for depression when women are in our care, we can get them the help they need.”
The emphasis in the new program is not just on screening, but also on connecting women with resources to help them overcome their illness. The screening is directed by the Department of Obstetrics and Gynecology in partnership with the departments of Nursing, Social Work and Psychiatry and Behavioral Neurosciences.
“Less than 50 percent of women who experience depression ever receive treatment for it,” says Itai Danovitch, MD, MBA, chair of the Department of Psychiatry and Behavioral Neurosciences. ″But when depression is identified, effective interventions can be offered. It is vital for new mothers to know that depression is common, that depression is treatable, and that, like many other medical conditions, recovering is fundamental to improving long-term health and wellness.”