Perinatal mood and anxiety disorders (PMADs) impact one in five pregnant people, making them the most common complication of pregnancy and one of the most underdiagnosed. Screening for PMADs during pregnancy and the postpartum period is important in order to determine if additional support may be required.
The American College of Obstetricians and Gynecologists (ACOG) recommends that screening for perinatal depression and anxiety occur at the initial prenatal visit, later in pregnancy, and at postpartum visits using a standardized screening tool, such as Edinburgh Postnatal Depression Screen (EPDS) or Patient Health Questionnaire (PHQ-9). The reality today is that the recommended intervals of screening for perinatal mood and anxiety disorders (PMADs) are often not followed and/or many women can under report symptoms (especially if postpartum follow up visits are rushed or skipped altogether). This leads to many mothers being underdiagnosed or undertreated and ultimately negative consequences to the mother and baby.
The onset of PMADs can appear as depressive or anxious feelings that occur during pregnancy (prenatal) and throughout the first year after pregnancy (postpartum). This is different from the “baby blues” that may occur only within the first couple of weeks postpartum where new mothers experience weepiness and mood swings. Without treatment of PMADs, symptoms may intensify and last anywhere from a few weeks to even years. Regardless of the symptom severity or point in the perinatal journey, help is available.
How to screen for perinatal mood and anxiety disorders (PMADs)
OBGYN providers, midwives, and mental health therapists are some examples of providers that can help screen and diagnose your mental health. They should be following the minimum screening intervals that ACOG recommends, although Postpartum Support International (PSI) suggests a minimum of 9 screening intervals as a best practice. PSI recommends screening at the 1st prenatal visit, 1x in second trimester, 1x in third trimester, 1st postpartum OB visit (usually at 6 weeks), at 6 and/or 12 months in OB and primary care settings, and at the 3, 9, and 12 month pediatric visits. This best practice reflects a more extensive period where the onset of PMADs can occur at any point during pregnancy and up to one year postpartum (far beyond the 6 week OB postpartum visit).
Self-screening is also an option and often it can be accomplished with the assistance of a non-medical support person, such as a doula, partner, friend, or family member. Self-screening does not lead to a diagnosis but the scoring can determine if seeking professional mental health support is suggested in order to obtain a diagnosis and effective treatment. The Edinburgh Postnatal Depression Screen (EPDS) and Patient Health Questionnaire (PHQ-9) are two common screening tools. With both of these tools, a self-screening score of 10 points or higher would result in the recommendation to seek out mental health support as a next step.
Fathers are also susceptible to PMADs and, in fact, 1 in 10 fathers experience postpartum depression and/or anxiety. The EPDS screening tool can be an effective measure of mood in fathers. Screening for depression or anxiety disorders in fathers requires lower cut-off than screening for depression or anxiety in mothers. The score of 5-6 for fathers would result in the recommendation to seek mental health support.
Local Perinatal Mental Health Clinics
LATCH Breastfeeding and Postpartum Wellness Center located in downtown Fayetteville offers maternal mental health support services. They accept all insurance and no provider referral is needed.
Anchor Perinatal Wellness located in Raleigh offers in-person and Telehealth individual therapy, group therapy, or intensive outpatient treatment programs for those who are most at risk for severe PMADs. They also offer free PMAD screenings on Mondays and Wednesdays.
National Perinatal Mental Health Resources
Postpartum Support International offers over 50 different free weekly online support groups led by trained PSI facilitators. Connect with other parents and gain access to helpful tools and resources.
Call or text the Postpartum Support International hotline for mental health support at 1-800-944-4773 (4PPD) #1 En Español or #2 English. Text in English: 800-944-4773 or Text en Español: 971-203-7773.
If you’re experiencing thoughts of harming yourself or someone else, call the National Suicide Prevention Hotline at 988 or 911 if you are experiencing an emergency.
Looking for a more supported birth and postpartum journey? Hire a doula! Our team is ready to support you and to help ensure you feel supported every step of the way. Contact us today to learn more.
