Is it possible to detect perinatal depression during pregnancy?

Transcription

1 Is it possible to detect perinatal depression during pregnancy? Svend Aage Madsen, Birgitte Bibow, Sarah Tranekær-Rasmussen, Anette Sonne Nielsen, H.C. Møller, Cecilie Skougaard

2 Official numbers in Denmark Post natal depression Incidence in women: ca. 10% Incidence in men: ca. 6 % National Board of Health

3 Perinatal depression has impact on the parents behaviour

4 Perinatal depression and parent behaviour Parents:

5 Long term impact on the child from both mothers and fathers depressions

6 Perinatal depression has impact on infant behaviour Babies:

7 Objectives of the study To investigate if: perinatal depressions are detectable during pregnancy it is possible to identify fathers with perinatal depression, it is possible to conduct a screening at the GP s in the 24th week of pregnancy for both men and women the mothers and fathers to be, who score above the cut off, want to be offered psychological treatment. Further, the project aim to compare prevalence and symptoms of perinatal depression among parents to be, with parents 6 to 8 weeks after the birth of their child.

8 Screening mothers and fathers to be Who: 30 practitioners in Central Copenhagen during 18 months What: Offered all their pregnant patients and their partners to be screened for perinatal depression When: At the 24th week pregnancy GP consultation

9 Screening mothers and fathers to be 1206 expectant mothers and fathers participated Which were 681 expectant mothers and 525 expectant fathers 56,5 % women and 43,5 % men

10 The screening form 1

11 The screening form 2

12 The screening instruments The screening instruments were the same for men and women. Consisting of: The Edinburg Post-Natal Depression Scale (EPDS) The Gotland Scale of Male Depression (GMDS) And selected questions from The Masculine Depression Scale and The Father Attachment Interview. All who scored above cut-off were referred to psychological treatment within a week.

13 EPDS ( Traditional depression) Unable to laugh or be humorous Unable to look forward to things Blaming myself unnecessarily when things go wrong Feeling anxious or worried for no good reason Feeling scared or panicky for no good reason Things get on top of me Have been so unhappy that I have had difficulty sleeping Feeling sad or miserable Feeling so unhappy that I have been crying The thought of harming myself has occurred to me

14 Gotland Male Depression Scale (GMDS) Lower stress threshold/tolerance/feeling more stressed Feeling aggressive, outward-reacting, low impulse control Feeling burned out and empty Inexplicable fatigue Feeling irritable, restless and frustrated Difficulty making everyday decisions Sleeping too much/too little/sleeping fitfully Difficulty falling asleep/early waking Feeling agitated/anxious/uncomfortable Excessive use of pills and/or alcohol Excessive activity: working, jogging etc. Altered behavior, difficult to be around Perceiving oneself/others perceive one as gloomy, negative Feeling / others perceiving one as moaning, self-pitying

15 Results 1 1,206 screenings of expectant mothers and fathers for perinatal mood disorders in the 24th week of pregnancy. 10 % of all parents to be were at risk of perinatal depression, i.e. scored above cut off. Women : 11 % of all women Men : 8 % of all men

16 Official numbers in Denmark Post natal depression Incidence in women: ca. 10% Incidence in men: ca. 6 % National Board of Health

17 Results 2 The screening instrument for both fathers and mothers to be included Edinburgh Post-natal Depression Scale (EPDS) and Gotland Male Depression Scale.(GMDS) Men score 7 % higher on Gotland Scale than on Edinburgh Scale Women score 30 % lower on Gotland Scale than on Edinburgh % of men with perinatal depression are only found using GMDS % of women with perinatal depression are only found using GMDS

18 Results 3 Data regarding the effect of treatment is not yet available, but: Positive feedback from the treated parents Positive feedback from the psychologists Feedback from the midwifes at Rigshospitalet stating that they have found fewer perinatal depressions in the parents after birth

19 The treatment model: Minding the parent-child-relationship A mentalization-based parent treatment aimed at: Helping the parent to understand and reflect on his or her own and the child s mental states. Understanding both the parent s own and the child s behaviors as based on mental states and thereby as comprehensible Reducing the parent s state of discomfort, supporting the development of their parenthood and helping to build attachment with the infant

20 Conclusions 1 It is possible to detect perinatal depression in men and women already during pregnancy Both expectant mothers and fathers accept to be referred to psychotherapy We believe that early treatment can prevent or reduce negative impact of the perinatal depression on the child We suggest that a systematic screening of expectant parents should be offered at the GP s, by midwifes or by health nurses family visit during pregnancy.

21 Conclusions 2 Men also suffer from perinatal depressions However they are seldom identified And even more seldom treated We suggest that all the GPs and the health nurses tests, help and treatment for expectant parents should be family orientated and be given to both men and women when ever appropriate

22 Something to read:

23 Thank you!