As I shared with you earlier this week, new research has found that a blood test may be able to identify postpartum depression in the future. Dr. John Grohol at Psych Central has followed up on that news with some commentary about how a blood test in the future might lead to even fewer OB/GYNs doing screenings of pregnant and postpartum women and asking them the kind of questions that should be asked. He makes a great point. Find the story here.
It's true that we have very effective screening tests right now that can be used to identify women who have postpartum depression, and it's true that not enough doctors use them. Dr. Grohol posits that the reason is " … because doctors are either unaware of these screening tests, or trust in their own clinical judgment …" Trusting in clinical judgment doesn't work. Researchers Wilen & Mounts found that, when screening for depression in the healthcare setting is based on clinical observation alone, 50% of women suffering from depression are missed. And Olsen et al found that pediatricians rarely identify maternal depression through a routine inquiry about symptoms. It is clearly important that screening tools like the Edinburgh Postnatal Depression Scale be used to identify PPD effectively.
Iagree with Dr. Grohol's assessments, but I believe thereis another significant contributing factor to the lack of screenings: Many docsdon't have psychiatric resources available to offer a patient should her screening test indicate the need for professional treatment.
This story from last week in the St. Cloud Times points out a problem we have around the country: a lack of mental health professionals that is leading people to long waits or no treatment at all. We have even fewer healthcare providers with any kind of training or experience treating women with perinatal mood and anxiety disorders.
"Angela Broska-Smith is a clinician at St. Cloud Hospital's Recovery Plus who suffers from anxiety. She had to go to a primary care physician for medication.
'I had postpartum depression, and I started using medication that had been prescribed for pain … and things got worse and worse until I ended up in a substance abuse program,' said Broska-Smith, who formerly worked at Lutheran Social Service.
She is worried others who struggle with mental health issues can't afford the time off, or the expense of travel, to find an available psychiatrist."
WhenI do speeches all around Georgia about perinatal mood and anxiety disorders I hear directly from staff and doctors at OB/GYN officesand labor & delivery nurses who say they do want to screen but have nowhere to send their patients. There is either a lack of mental healthcare services entirely, or there are a handful of people but none have any experience treating women with these illnesses. We need to make sure that every state has organizations like the Postpartum Health Alliance in San Diego,Postpartum Support Virginia, thePostpartum Resource Center of New York, the comprehensive network of Postpartum Support International, PSI ofWashington State,and the fledgling Georgia Postpartum Suport Network to identify every resource available and to work with the healthcare community toget even more developed. And we need to make sure that the psychiatric professionals who are out there are aware of the toolstheycan access togetbetter educated on perinatal moodand anxiety disorders, likePSI's training workshopsor books like Therapy & the Postpartum Woman: Notes on Healing Postpartum Depression forClinicians and the Women Who SeekTheir Helpor Perinatal& Postpartum Mood Disorders: Perspectives & Treatment Guide for the Healthcare Practitioner.
