Introduction
Worldwide, many pregnant females and women in the first year after giving birth have perinatal and postpartum depressive disorders. Postpartum depression (PPD) is a global health problem prevalent in developed and developing countries (Kariuki et al., 2021). Depression may severely impact a mother’s health and raise the danger of preterm labor and low birth weight (Noda et al., 2022).
Untreated depressive disorders can make it more likely for women not to follow their doctors’ orders, use tobacco and other drugs more frequently, make other medical disorders worse, and even result in suicide and homicide (Gisseman et al., 2021). Untreated maternal depression can harm a child’s development and functioning, the mother-infant attachment, and the likelihood that a child will experience anxiety and depression symptoms later in life (Inekwe & Lee, 2022; Thomas, 2020). Therefore, several significant healthcare organizations advise comprehensive screening for depression in pregnant patients.
The standards specified by the World Health Organization (WHO) to advise policymakers on the benefits of population-based screening are satisfied by assessing prenatal and postpartum females for depressive disorders. Depression is an issue for public health since it has a detrimental influence on relationships, work, physical and psychological well-being, and quality of life (Guo et al., 2022; Shuffrey et al., 2022). Since depression has a wide range of indications and an unpredictable start, screening is likely to identify cases of the illness that may otherwise go undetected.
There are screening techniques and treatments that patients can accept. Compared to standard treatment, screening schemes for prenatal and postpartum females lower the relative risk of persistent depression at 3 to 5 months by 18% to 59% (Learman, 2018, p. 528). Screening test evaluations are made in comparison to an established gold standard for diagnosis. A systematic interview that will disclose all the elements included in DSM-5 is the golden standard for identifying depression. It should be mentioned that depression screening tools are mostly focused on MDD in this case (Anokye et al., 2018).
Nevertheless, the potential to enhance timely postpartum depression treatment and maximize family well-being through regular screening can save costs in the dimension of the health system. However, there are discrepancies in standard screening guidelines worldwide involving the use of specific screening tools and cut-off values (Premji et al., 2019). Furthermore, there needs to be more research addressing the rates of PPD detection and therapy after the screening.
Not all societies have followed the advise of various groups advocating for screening all pregnant and postpartum females for depression. A short study of maternity practices in inner cities found that 28% of the post-visit records had no information about the patient’s psychological health (Gisseman et al., 2021).
In addition, the obstetricians in the study did significantly worse at recognizing depressed symptoms in the absence of a screening instrument. Only 13% of research participants were recognized as being at risk based only on their medical history and physical examination, but 22% of participants tested positive for depression. The provided information appears to add significance to the debate on the use and failure of usage of a perinatal depression screening tool and the impact this has on risk identification and diagnosis.
Using JMP v13.2, it is possible to perform statistical computations, as demonstrated by studies that are comparable to this one and fall under the theme. ANOVA with a Tukey correction may be used to evaluate constant variables utilizing averages and standard variances (Gisseman et al.,
2021). The Mann-Whitney test can be used to describe categorical variables using the median and interquartile ranges in non-normal datasets. Then, the following formulation of ethical principles could serve as the foundation for the investigation. First is informed consent – participants must be comprehensively provided with information about the research without duress. Second, it is confidentiality – no personal data can be revealed without participants’ permission. Third, it is integrity – the study should be transparent and follow the best academic practices.
Literature Review
Postpartum depression (PPD) is a prevalent medical complication globally, both in developed and developing nations. This is the case among neonatal and perinatal women, with statistics indicating that it befalls 10 to 15% of new mothers (Alonazi & Jahan, 2022, p.1). Particularly, certain groups of women have been identified to be at higher risk. These include adolescents, inner-city women, and mothers of infants born before full term. In 25 to 50% of women, PPD perseveres for over seven months (Slomian et al., 2019, p1).
According to Mughal et al. (2022), lengthy after-birth episodes of depression can cause a relational or social maternal problem even post-recovery. PPD has been referred to as an emotional mood disorder with symptoms similar to those linked with postpartum blues. However, Chen et al. (2022) add that PPD distinctive symptoms go past two weeks after delivery. PPD definition varies from other forms of depression as far as the time frame is concerned.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines PPD as a depression illness that includes a peripartum onset, precisely encompassing the beginning of significant episodes of depression, which happens four weeks after birth or in the course of pregnancy. Its symptoms include insomnia, hyper-insomnia, and changes in appetite.
Similarly, it contains significant to moderate symptoms of anxiety and somatic complaints, including headaches, chest discomfort, and fatigue for about two weeks (Slomian et al., 2019). Day and Matorin (2019) add that PPD has other common symptoms: guilt, confusion, dysphoria, harboring suicidal ideas, and emotional instability. A study by Chin et al. (2022) indicates that suicide is among the principal causes of postpartum maternal death. Such deaths are particularly rampant within six months of delivery.
The treatment and diagnosis of PPD are imperative to ensure women in the postpartum period generally enjoy good well-being. PPD affects developing and developed nations alike; statistics indicate that one out of 10 women often has depression symptoms, with about one in nine having PPD symptoms. The CDC, by utilizing self-reported data from a Prenatal Risk Assessment and Monitoring System (PRAMS), indicates a higher occurrence of PPD among blacks than their white counterparts.
Nonetheless, among the low-income and racial and ethnic minorities in Saudi Arabia, Alonazi and Jahan (2022) found out that women were not likely to be treated or even diagnosed with PPD. Another study in Saudi Arabia by Alzahran et al. (2022) established that risk factors with moderate to robust links with PPD comprised poor social support, marital relationships, and low self-esteem.
It is extensively known that there are prevailing challenges with the screening of PPD by healthcare providers as a care standard. A survey conducted by Chen et al. (2022) among gynecologists and obstetricians reported that 36.8% of respondents had consistently utilized a validated screening tool (p. 7).
On the other hand, 50.6% had never used a validated screening tool to assess maternal depression (Chen et al., 2022, p. 7). A study by Slomian et al. (2019) involving the examination of over 4,000 women at 4 to 6 weeks postpartum indicated that only 63% of the women reported being questioned about their state of emotions by a clinician. The others were not asked regarding their emotional state during their postpartum visit.
Nonetheless, the Translating Research into Practice for Postpartum Depression (TRIPPD) program is the initial effectual study to report enhanced maternal outcomes and processes. The study entailed the execution of PPD follow-up and screening services from skilled staff members (Alonazi & Jahan, 2022). The effectual follow-ups diminished women’s need to seek mental healthcare and evaluation services outside their chief care practice. Yet, still, erratic practices of PPD screening are rampant, irrespective of having evidence that is well-documented of the imminent adverse implications. Interventions that include identification of PPD, care-seeking services commencement, efforts at the system level to support care management, and offering provider education are disparagingly needed to ensure PPD-linked outcomes are enhanced.
Nurses have in the past recommended the screening of all women for anxiety disorders and perinatal mood in the course of the postpartum and prenatal periods. Routine screening in these periods would help detect early maternal depression signs, enabling effective perinatal anxiety and mood disorder management. This helps in health and welfare advancement among children and women. Most healthcare amenities offering neonatal and perinatal care have developed protocols and policies addressing PPD screening and education for mothers.
They have also come up with techniques to train staff for depression disorders. Despite such attempts, a significant number of facilities remain. Specifically, in developing countries such as Saudi Arabia, though they have developed protocols and policies, they fail to utilize a postpartum depression screening tool fully. To entirely understand the grasp of the peril that this may pose, further research is needed. This will aid in addressing the effects of utilizing or failing to use a postpartum depression screening tool on the diagnosis or identification of peril.
Methodology
This segment provides information about data collection and statistical analysis to determine the effects of employing or failing to use a postpartum depression screening tool and the effect it has on risk identification and diagnosis. The research was carried out between January 2022 and December 2022 in primary healthcare centers in Al Kharj in the Kingdom of Saudi Arabia. It is a cross-sectional and observational study involving interviews and questionnaires to collect data. It measured the identification and diagnosis of risk factors when a postpartum screening tool was used and when not used to detect PPD.
An English version of the EPDS questionnaire was distributed to willing participants. EPDS was utilized as a validated screening tool to measure postpartum and perinatal depression symptoms among women. Interviews were conducted among women as the no-screening tool. The questionnaires were distributed to the primary healthcare clinics, and qualified nurses disseminated them to the willing participants. The questionnaire was twofold; the initial one encompassed basic information such as name and medical history. The second part included self-administered EPDS, a valid and reliable scale to detect PPD symptoms.
Interviews were also conducted in the same primary healthcare clinics by qualified nurses but on different postpartum and perinatal women to those EPDS was administered.
The JMP v13.2 software and ANOVA with a Tukey correction were used to compare variance across the EPDS questionnaire group and the interview cluster. The JMP software was used to calculate the number of needed participants statistically. There was a total of 376 mothers who responded both to the EPDS and the interviews, and based on ANOVA repeated measures, it was determined that each group needed a minimum of 28 participants. Of the 376 respondents, 200 failed to meet the criteria, and 88 responses were used for each group.
Results
During postpartum, various measures are utilized to assess symptoms of depression. Nonetheless, some of these instruments are not designated screening tools. This is the case with postpartum and perinatal interviews in this study. Interviews only serve to gauge the general PPD symptoms and the related distress. Most importantly, the psychometric properties of interviews and other tools have not been fully characterized.
Conversely, various other studies have established particular screening tools that examine postpartum depressive disorders. Among them is the EPDS, which is present in multiple validated forms and can be used in various languages. During postpartum, EPDS is the most extensively utilized scale to detect postpartum depression. EPDS aims to aid health professionals in screening postnatal mothers’ community samples for depressive symptoms after delivery. It has been utilized in various countries owing to its effective specificity, sensitivity, and positive prediction values.
Conclusion
The interviews proved to be less effective as far as detecting PPD is concerned. Comparing the sample group that was interviewed to that which EPDS was utilized, the one who was interviewed recorded fewer PPD diagnoses. This indicates the low effectiveness of not using PPD screening tools, which has the implications of a deficiency in the identification or diagnosis of risk. This can cause the escalation of PPD, leading to emotional and even physical trauma and, at worst, suicide. On the other hand, EPDS showed great accuracy, and those who tested negative for PPD did not develop any depression-like symptoms.
This was in contrast to the case with interviews, exemplifying the efficacy of EPDS in risk identification and diagnosis. Consequently, this illustrates that using screening tools increases the specificity and sensitivity of PPD detection, translating to better identification and diagnosis of the risk. It is thus correct to say that in perinatal women, utilizing a postpartum depression screening tool during the period results in better identification or diagnosis of risks involved, including the development of the related symptoms.
References
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