New guidelines suggest depression screenings amid stress of pregnancy

There's new evidence that postpartum depression is more common than previously believed, according to the U.S. Preventative Services Task Force, which calls for women to be screened during pregnancy and again after giving birth. William Brangham discusses the recommendations with Dr. Hal Lawrence III of the American Congress of Obstetricians and Gynecologists.

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    A federal health panel is now calling for all women to be screened for depression during pregnancy and again after giving birth.

    The U.S. Preventive Services Task Force says there's new evidence that postpartum depression is more common than previously believed. The report also recommends that all adults over 18 be screened for depression.

    William Brangham zeros in on the new guidelines and how they apply to women.


    Today's recommendations follow recent research suggesting that as many as one in five women may develop depression, anxiety or other forms of mental illness within a year of giving birth.

    Joining me to discuss this is Dr. Hal Lawrence. He's a longtime OB/GYN and currently the CEO of the American Congress of Obstetricians and Gynecologists.

    Dr. Lawrence, welcome. Thank you for being here.

    DR. HAL LAWRENCE III, American Congress of Obstetricians and Gynecologists: Thank you for inviting us.


    What was your reaction when you first heard these guidelines? Was this good news to you?


    It's excellent news to us.

    At the American Congress of Obstetricians and Gynecologists, we have been aware for decades about the risk of postpartum depression, and, in all honesty, the risk of depression in women at any — throughout their life.

    You know, one in five women, or 20 percent of all women, will have a major depressive episode during their lifetime, and pregnancy and other stressful events increase that for them.


    Why is it — I'm curious. Just why is it that pregnancy is a particular trigger for that?


    Well, it's such a stressful time. And everybody looks at pregnancy as this joyous moment.

    And it is joyous, and you have a healthy mother, and you have a healthy baby. But there's also a lot of stress. That woman's life has changed. She feels — she's so dedicated to her baby. And then anything that makes her feel uncomfortable, she questions herself: Am I doing the right thing? Am I doing it good enough?

    And for some women, that just sort of works through with the postpartum blues, which almost every postpartum patient has. But, by a week or two or three weeks, that really passes. But for about 20 percent, it doesn't. It hangs on for a while, and they actually have some depression. And then, for a much smaller group, around 2 percent, they can actually go into something called postpartum psychosis, which they can have ideations of suicide, hurting themselves, hurting their baby.

    And it's all because of the stress of that period, and at times feelings of not being what they want to be or being what people expect them to be.


    These recommendations indicate that mothers should be screened not just after the birth, but during their pregnancy. And I wonder why — is it that signs during pregnancy tend to show up?


    Well, as I said, we know that 20 percent of all women will have some depression during their lifetime, and so some women actually enter pregnancy with some signs of depression.

    Some may have already had a diagnosis of depression or psychological illness, and those people are at increased risk. So, picking that up early, or if you don't know about it, helps you be careful about those parents when they become postpartum.

    So, screening during pregnancy is very important. Screening postpartum is very important, and screening, you know, earlier than even six weeks. You know, it's interesting. Many times, the pediatricians who are seeing the babies back for growth checks and weight gain and all that will pick up on this, because there will be…


    Pick up on the mother's behavior.


    Exactly, because there's this detachment between the mom and the baby, which is not normal.

    And they — oftentimes, the pediatricians will call and say, hey, there's something going on here. You need to see Mrs. Jones, because it's — they sense that.


    If you were a doctor sitting opposite me, what does a screening for depression look like or sound like?


    Well, actually, there are some tools that are out there. They have this Edinburgh postpartum depression screen, which has a series of questions that are very simple and straightforward. It takes just a few minutes for the patients to fill out.

    You can quickly grade it, and based on how you grade it, gives you an idea as to how this woman's emotional stability is at that time. So, we recommend that or a tool like that for everybody to utilize.


    The reason I ask about this is that whenever we have a — for instance, a major episode of gun violence, people always talk about the need to increase mental health care in this country.

    And one of the retorts to that is always, we don't have the mental health infrastructure to handle all those people. I'm just wondering, do you think that there's a concern that these guidelines might be recommending services that we don't have the ability to deliver?


    Well, I think we have to have the ability to deliver those services.

    And, yes, there is a good reason to expand mental health services in this country. But when you look at the postpartum patient, I think it's really a team. Yes, oftentimes, you need a psychologist or a psychiatrist, but, many times, you need an alert pediatrician, an alert and sensitive obstetrician/gynecologist, family members who see this is going on, and that team working to help support and ensure that the mother's getting the support and care she needs.

    We have to — when we recognize it — I mean, I have practiced for almost 30 years and delivered over 5,000 babies. I have made this diagnosis. I have started these people on treatment. You have to do that and see if you can't get them healthy.


    Dr. Hal Lawrence of the American Congress of Obstetricians and Gynecologists, thank you very much.


    Thank you. It's a pleasure to be here.

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