Common Mental Disorders Depression - New Zealand Doctor

during pregnancy, of which up to 6% meet diagnostic criteria for major depression.
Up to 19% have an episode of major or minor depression within 3 months of
childbirth, of which about 7% are major depression. 100
Depression is associated with a wide range of negative outcomes potentially affecting
the mother, newborn and wider family. These include obstetric and perinatal
difficulties, 105 poor mother-child interaction, 106 mental disorders in male partners 109
and long-term developmental problems in offspring. 107,108,434-436 In severe cases there
is a risk of child/fetal neglect or abuse and maternal self-harm. 101
A systematic review of literature on risk factors for postnatal depression found that
potentially important factors were the mother’s level of social support, life events and
psychiatric history. 101 Depressed mood or anxiety during pregnancy were the strongest
predictors of postnatal depression. 101 However, it has been reported that many women
presenting with postnatal depression in primary care in New Zealand do not have
identifiable risk factors, such as poor social support or partner relationship problems. 103
For most women with an identified or suspected mental disorder during the antenatal
or postnatal period, assessment and treatment will take place in primary care,
coordinated by the general practitioner. 101
7.2 Screening of women in the antenatal
and postnatal period
Women with a previous history of a serious mental disorder face a substantial
risk of recurrence following delivery. 101 The practitioner should ask a pregnant
woman about any history of mental disorder or any family history of mental illness
in the antenatal or postnatal period, as part of routine antenatal care during her
pregnancy. 101 An appropriate management plan can then be set up for those at
risk. 432 It is inadvisable to use the term postnatal depression as a generic term for
all types of postnatal psychiatric disorder, as it may give false reassurance regarding
the nature of previous episodes of illness. 437
There has been debate in the literature about targeted screening for common mental
disorders in the antenatal and postnatal period in primary care, and which tool(s)
should be used. 101,438,439 Targeted screening is defined as administration of a tool
designed to identify common mental disorders, administered to a selected patient
population (in this case, women in the antenatal and postnatal period) presenting
in primary care.
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Identification of Common Mental Disorders and Management of Depression in Primary Care