2002 International International Biennial Scientific Meeting

CAN POSTPARTUM DEPRESSION BE PREVENTED?

Meir Steiner, Margaret Fairman, Karen Jansen, and Shannon Causey

Women's Health Concerns Clinic, St. Joseph's Healthcare, Departments of Psychiatry and Behavioural Neurosciences and Obstetrics and Gynecology, McMaster University, Hamilton, Ontario

mst@mcmaster.ca

Objectives: A common theme found among postpartum patients seen at the Women's Health Concerns Clinic (WHCC) was a lack of sleep during their hospital stay after delivery. Based on this observation, a protocol was instituted to offer women at risk of postpartum depression measures to help reduce sleep deprivation while in hospital. Risk factors were previous episodes of postpartum depression, prior or current mood disorders and family history of mood disorder or alcoholism. The optional measures included an extended maternity ward stay (up to 5 days) with a visit from the WHCC team on day three or earlier if the patient wished to leave hospital, rooming out of newborns at night, lorazepam on a p.r.n basis and a private room. The objectives of this study were to see which women would use the optional measures and to assess the effectiveness of the measures in reducing postpartum symptoms.

Study Design: Charts of all clinic antepartum patients since 1996 were reviewed and patients were contacted by telephone. Data on risk factors, actual use of measures, the presence and severity of postpartum depression, use of antidepressant medication and the need for psychiatric postpartum admissions was gathered.

Results: A total of 179 charts were reviewed. Patients with a history of postpartum depression were more likely to follow protocol suggestions. The average Edinburgh Postpartum Depression Scale score was 11, lower than the cut off usually required to establish the diagnosis of an episode of depression; only 6 mothers required a psychiatric admission.

Conclusions: Having the knowledge that a support system was in place, the experience of a better sleep in hospital and health teaching to patient and spouse (re: shared night time responsibility for childcare and mother's rest) appeared to reduce the incidence as well as the severity of depression in this high-risk population. A randomized controlled study is proposed with greater emphasis on adherence to protocol to further quantify the potential benefits of this program.

References:

1) Thompson J et al (2000) Early discharge and risk for postnatal depression. Med J Aust 167:244-247.

2) O'Hara M et al (1986) Social support, life events and depression during pregnancy and the puerperium. Arch Gen Psychiatry 43;569-573.