Postnatal depression in Japanese women: Detecting the early onset of postnatal depression by closely monitoring the postpartum mood

Abstract

Objectives: The terminology and definition of mood disturbance during the early postpartum period has yet to be clearly elucidated among clinical practitioners. Criteria for maternity blues have not been well established, and it may overlap with the beginning of a postnatal depression. The aims of the present study, are firstly to survey the symptomatic features of mood disturbance in the very early postpartum period and secondary, to develop a guideline for detecting and predicting postnatal depression during the same period using a simple screening technique. Subjects and methods: Eighty-eight mothers recruited from a maternity ward for the prospective study completed the whole protocol. Two methods were used to survey the symptomatic features of mood disturbance; (1) interview and (2) self-report questionnaires. The interviews were carried out twice. At three weeks postpartum, the Schedule for Affective Disorder and Schizophrenia (SADS)/Research Diagnostic Criteria was administered, together with an interview of the symptoms of “maternity blues”. The SADS interview was re-administered at three months postnatally. Two self-report questionnaires addressing mood disturbance were administered: (1) Maternity Blues Scale; ( Stein, 1980). (2) Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987). The Maternity Blues Scale was administered on the first five consecutive postnatal days. The EPDS was administered on the fifth day, one month and three months postnatally. In addition, the Life Event Scale ( Burgha et al., 1985) was also administered at one month postnatally. Obstetric notes were also examined. Results: At the first interview, 12 mothers were diagnosed with postnatal depression and 10 of these had their onset within one week. At the second interview three additional mothers were newly diagnosed with depression. In all mothers, depression was detected at one month using the EPDS, with a cut-off of 8/9. The EPDS scores on the fifth postnatal day were also higher in the depressed mothers and could detect early onset of postnatal depression. Conclusion: The use of the EPDS during the early postnatal days, can be a simple and useful screening instrument for the onset of early postnatal depression.