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Postpartum Depression and Anxiety Screening During Ponseti Casting
Melissa A Bent1,2, Taylor Cosanella1, Abigail N Padilla1
1Children's Hospital Los Angeles, Autry Orthopedic Center.
Insights
Postpartum anxiety and depressive symptoms are common in mothers of infants with clubfoot. Screening for postpartum depression in clubfoot clinics is crucial for supporting families during Ponseti casting treatment.
Area of Science:
- Pediatric Orthopedics
- Maternal Mental Health
- Public Health
Background:
- Congenital clubfoot is a common birth anomaly impacting infants and parental well-being.
- Maternal psychological health is significantly affected by infant diagnoses like clubfoot.
- Early identification of postpartum mood disorders is essential for timely intervention.
Purpose of the Study:
- To determine the prevalence of postpartum depression and/or anxiety symptoms in mothers of infants treated for clubfoot.
- To assess the utility of the Edinburgh Postnatal Depression Scale (EPDS) in a clubfoot clinic setting.
- To identify potential associations between positive screening results and clinical/demographic factors.
Main Methods:
- The Edinburgh Postnatal Depression Scale (EPDS) was administered to 56 mothers of infants with clubfoot.
- Screening occurred during the initial Ponseti casting visit for infants under 4 months old.
- Data analysis involved descriptive statistics and nonparametric tests, utilizing electronic medical records.
Main Results:
- 10.7% of mothers screened positive for postpartum depression (EPDS score ≥10).
- Commonly endorsed symptoms included difficulty coping and anxiety (50.0% each).
- Positive EPDS scores were significantly associated with subsequent evaluation by an orthopedic clinical psychologist (P=0.022).
Conclusions:
- The EPDS is a valuable screening tool for clubfoot clinics.
- While many mothers experience anxiety/depressive symptoms, clinical postpartum depression rates are similar to the general population.
- Integrating postpartum depression screening addresses critical mental health needs of families undergoing clubfoot treatment.
Introduction:
Congenital clubfoot is the most common musculoskeletal birth anomaly affecting infants. It may also have a profound impact on the psychological well-being of parents. The purpose of this study is to determine the prevalence of a positive screening for postpartum depression and/or anxiety symptoms for biological mothers whose infants were undergoing Ponseti casting for clubfoot.
Methods:
The Edinburgh Postnatal Depression Scale (EPDS) screening tool was administered by convenience sampling to mothers of patients with clubfoot being seen at a single pediatric tertiary hospital between February 2023 and June 2025. The tool was provided at the initial visit to mothers whose infants were under 4 months old with no prior clubfoot treatment. Data were collected through standardized EPDS assessment and electronic medical records. Descriptive and nonparametric statistics were used for data analysis.
Results:
There were 56 biological mothers who completed the EPDS in clubfoot clinics. The median EPDS score was 3 out of 30 (IQR: 6.5). The prevalence of mothers who met the clinical cutoff for postpartum depression, defined as an overall score of ≥10, was 6/56 (10.7%). Mothers endorsed symptoms such as difficulty coping (50.0%) and feeling anxious (50.0%). For those who screened positive for postpartum depression, there was no association with age at initial visit ( P =0.640), race ( P =0.663), idiopathic or nonidiopathic clubfoot ( P =0.119), prenatal diagnosis ( P =0.168), prenatal consultation ( P =0.670), pregnancy complications ( P =0.186), and insurance type ( P =0.670). There was a significant association between a positive EPDS score and being seen by the clinical psychologist beyond the initial visit ( P =0.022). Mothers who screened positive were evaluated by the orthopaedic clinical psychologist.
Conclusion:
The EPDS screening tool has a role in the clubfoot clinic. Most mothers endorsed postpartum anxiety and/or depressive symptoms, though they did not meet the cutoff for clinical postpartum depression. This prevalence is similar to the reported literature in the general population. This study highlights the importance of incorporating postpartum depression screening in clubfoot clinics to address the mental health needs of families undergoing Ponseti method clubfoot care.
Significance:
Postpartum anxiety and depressive symptoms are endorsed in mothers of infants with a clubfoot diagnosis, and postpartum depression screening is important to address the needs of families undergoing clubfoot treatment.
