Research from the U.S. Centers for Disease Control and Prevention shows that about 1 in 9 women in the U.S. experience symptoms of postpartum depression. But those numbers differ by age, race or ethnicity and state, so in certain groups of women, the rate may be as high as 1 in 5. And that figure may still be low; one study says that “fewer than half of cases are recognized.”
One reason for that may be in how women are screened for postpartum depression, or PPD. For the past three decades, the gold standard in diagnosing PPD has been a tool called the Edinburgh Postpartum Depression Scale, or EPDS, but mental health experts agree that this 10-question tool is flawed. According to researchers at Massachusetts General Hospital‘s Ammon-Pinizzotto Center for Women’s Mental Health, it’s only right about 75 percent of the time and produces false positives in 25 percent of women.
Believing that there might be a better way to screen for PPD, the researchers developed their own tool, which they call the MGH Perinatal Depression Scale, or MGHPDS. The tool is offered as a free smartphone app, and its designers hope that as women around the world use the tool, their feedback will help them make it shorter, simpler and more effective.
[Read: How Do I Know If I Have Depression?]
The app currently can be downloaded in both Apple and Android versions, with version 2.0 of the app launching in the second half of 2018. It includes questionnaires about mood, anxiety, sleep and stress at important time periods during and after pregnancy. The current scale also includes 10 questions, but it will eventually be refined to four or five questions as, over time, the questionnaires identify which symptoms are most critical in the diagnosis of PPD in women ages 18-45 who are pregnant or up to 12 weeks postpartum.
‘The Stars Have Aligned’
The rationale behind the new scale, says Dr. Lee S. Cohen, director of the Ammon-Pinizzotto Center and professor of psychiatry at Harvard Medical School, was an increased focus on the value of PPD screening over the past several years around the country, thanks in part to the public advocacy of celebrities such as Brooke Shields and others. “The stars have sort of aligned, and we see more programs supporting women with PPD, so the extension of that is to take it to the clinical setting,” Cohen says.
Mandates in dozens of states have created commissions charged with improving PPD screening and treatment, and Cohen sits on one in Massachusetts. “We realized we could probably do better” than the EPDS, he says. “We decided to revise the scale to be shorter, easier to use and more specific to identifying PPD.”
[See: Am I Just Sad — or Actually Depressed?]
The EPDS asks women to answer 10 questions, including: “I have been able to laugh and see the funny side of things,” “I have looked forward with enjoyment to things,” “I have felt scared or panicky for no very good reason, “I have been so unhappy that I have been crying” and “The thought of harming myself has occurred to me.” Responses are made on a four-point scale from “never” or “not at all” to “a lot” or “almost all the time.”
Many clinicians, such as Dr. Donna Stewart, university professor and inaugural chair of women’s health at University Health Network and University of Toronto, think that’s too many questions. “I agree that the EPDS is too long for many situations, such as busy OB clinics,” she says. However, she notes that there are already other, shorter scales for depression and anxiety that she says “are highly recommended for screening of pregnant and postpartum women and total four questions. As these are well-validated and free, why not use these on a smartphone rather than designing yet another 10-item questionnaire that will need validation?”
Cohen counters that these other scales, though used widely by mental health professionals to screen the general population, “have not been studied extensively or with any large samples in pregnant and postpartum populations specifically. In contrast, the EPDS has been validated in numerous studies and in numerous countries in pregnant and postpartum women. So, to try to improve the EDPS and to make it shorter and more specific is intuitive, given the context in which it has been used.”
[Read: A Look at Depression Around the World.]
Using Technology for PPD
Cohen says that there has been rapid growth in the development of a variety of web-driven screening tools for many mental health issues, but “to date there has been little attention to the use of technology to better diagnose and treat PPD.” Creating a smartphone app “is a great idea,” Stewart agrees, though she adds that, from her perspective in Canada, the greater problem in the U.S. is lack of access to appropriate mental health care. “Why screen if you don’t have the services? It is important for women with depression to get care, there’s no question about that, but that’s where the gap is,” she says. Cohen doesn’t disagree. “If we ID the disease, we’ve only gone part of the way toward the goal, which is to mitigate suffering,” he says. “The majority women identified do not get adequately treated.”
Cohen and his team believe that this screening app is just a first step toward that goal. “This is a way to use digital technology to make screening easier for patients, that’s No. 1; and No. 2, using big data to come up with a shorter and more specific tool,” he says. “My vision is this will be coupled with treatment delivery tools — if you score a certain number, you have a link to a treatment tool — to couple specific screening with effective delivery of treatment, for getting women well and doing it in a timely way.”
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Is There a Better Way to Screen for Postpartum Depression? originally appeared on usnews.com
