[Screening and intervention for depressive mothers of new-born infants]

BACKGROUND AND THE AIM OF THE STUDY: Postnatal depression is a key concept for mother-infant mental health. Evidence of its impact on mother-infant relationship has been increasingly demonstrated in recent years. Therefore optimal intervention is important for women and their babies' mental health. Identifying risk factors of postnatal depression and developing screening system are needed. Study I Hospital-based prospective study--onset and course of Postnatal depression and developing screening system.

One hundred and one consecutive admitted women on maternity ward in our university hospital were invited to the study and 88 mothers participated. Present psychiatric status was assessed by telephone interview at three weeks and three months postnatally, using the Schedule for Affective Disorders and Schizophrenia and diagnosis was made based on Research Diagnostic Criteria. The Maternity Blues Scale and Edinburgh Postnatal Depression Scale (EPDS) were also administered at the 5th day, one and three months postnatally.

At 3 weeks, 21 of the 88 mothers (24%) were categorized as having had Maternity blues, and twelve (14%) were diagnosed as depression cases. At 3 months postpartum overall 15 of 88 mothers (17%) were categorized as depression cases. Ten out of total 15 mothers had their onset of depression within the first week. There were no differences in age, parity, educational level, social class compared to non-depressed mothers. The scores of the Blues and the EPDS were always significantly higher in depressed mothers. The Blues scale score was significantly higher in the depressed mothers compared to the control mothers at any timing of investigation. Even at the fifth postnatal day, 11 of 15 mothers who subsequently became clinical depression had already scored 9 or more, which is indicative of postnatal depression, this means postnatal depression could be detected from the very early postpartum period. As for the validity test of the EPDS, having set a cut-off point being 9 or more, the sensitivity was 82% and the specificity were 95% respectively. This score is the same as Okano reported in Japan and lower than many studies in Western countries. Study II Multi-centre prospective study of early postpartum mood states.

Fourteen obstetric wards in teaching hospitals participated in the study, and there, recruitment in each ward continued until 20 post-natal women had agreed to participate. Two hundred twenty six patients (89.7%) completed the study. During the first 5 days Maternity blues scale, and the EPDS on the 5th postnatal day, and one month postnatally the EPDS again were given to the mothers. The EPDS score of 9 or more was regarded as a probable case of postnatal depression.

Seventy-nine out of the 226 patients (35%) had maternity blues. Forty six out of the 226 patients (20%) had postnatal depression (EPDS being 9 or more) at one month postnatally. There was a significant correlation between the EPDS scores on the 5th postnatal day and those at one month. Having maternity blues and higher than 9 or more of the EPDS score were significantly related to the EPDS scores of 9 or more at one month postnatally. (odds's ratio = 4.4 and 13 respectively). Dysphoria on 5 day was significantly related to history of pregnancy loss, Caesarean section, Maternal and neonatal complications and Maternity blues. Dysphoria on one month was only related to Maternal complication.

The onset of postnatal depression can be within the first week after delivery. The use of the EPDS during the first week is a simple and useful screening for early onset case. Maternal complications and related medical factors might be the risk factors of mood disturbance during early postnatal period.