Why Screening Tools are Important
We’re here to help! If you have questions about using these screening tools, interpreting their results, or developing a treatment plan, please contact us.
- They provide an objective assessment of a patient’s thoughts and functioning.
- They may pick up factors that the clinician may not easily elicit or may not have time to ask.
- They can identify symptoms that patients may not know to report, may not recognize as unhealthy or pathologic, or may be ashamed to volunteer, fearing that others will consider them “crazy” or “unfit.”
All of the screening tools listed below are in the public domain and have been validated for the diagnosis of specific mental health disorders or symptom constellations. We provide suggestions about how best to use each tool, and what to do with results to determine next steps for your patient. Most of these tools can be completed by the patient in less than 5 minutes.
For an initial evaluation with a patient: We suggest you administer the Comprehensive Anxiety and Mood Survey (PDF). This tool contains four screening tools to help identify Major Depressive Disorder, Bipolar Disorder, Generalized Anxiety Disorder and Post-Traumatic Stress Disorder. These are the four disorders from which your patient may be most suffering. For scoring, download the Scoring Tool (PDF).
The American College of Gynecology, The U.S. Preventive Services Task Force, and the Centers for Disease Control recommend that all perinatal patients receive screening for depression.
In an obstetric office, patients should be screened at their first prenatal visit and again in the third trimester. Patients at high risk for Perinatal Mood and Anxiety Disorders (PMADs) should again be screened two weeks after delivery, while all patients should be screened at their six week postpartum appointment. We recommend that the survey be provided to the patient upon rooming, scored by nursing or medical staff, and then provided to the physician or Advanced Practice Provider.
The PHQ-9 is widely used for screening, diagnosing, monitoring and measuring the severity of depression in primary care and medical specialty practices. Questions include queries about physical and emotional symptoms. It can be used in adult patients, including pregnant or postpartum individuals. Importantly, it screens for suicidal ideation and accounts for the unique experience of the new parent.
The EPDS has been well validated and is sensitive and specific for moderate to severe depression detection. It can be used in pregnant patients as well as in the postpartum. The advantage of the EPDS is that it excludes questions about constitutional symptoms, which may simply be a result of pregnancy or early parenting such as fatigue or sleep difficulties. It also screens for suicidal ideation.
Elevated scores on a subset of questions (a total of 5 points or higher when combining answers for 3, 4, and 5) suggest anxiety as well as depression.
The EPDS is available in many languages. If you need translations of the EPDS into languages other than English or Spanish, please contact us.
More than depression, perinatal individuals experience anxiety symptoms. Only recently have medical professionals recognized that. Women have not shared their experience thinking that anxiety and worry were normal for new parents. Anxiety may prevent new parents from sleeping or caring for their babies and may be present with or without depression.
While some anxiety is to be expected when welcoming a new baby, anxiety can become an impairment at times. Anxiety that was tolerable before a pregnancy or baby can become overwhelming. The GAD-7 examines attitudes toward personal safety and the impact of anxiety on wellbeing.
Patients with GAD-7 scores greater than 9 will benefit from administration of the PASS, which may help determine which anxiety disorder(s) are present in the patient. The PASS looks at different forms of anxiety, including social anxiety, panic disorder, OCD and PTSD. The PASS relates specifically to fears and anxieties that may affect a pregnant or new parent.
PTSD & Birth Trauma
If your patient suffered a traumatic birth, a difficult pregnancy, infertility, or pregnancy loss, they are at increased risk for post traumatic stress disorder (PTSD). Parents of babies that require NICU admission or acute medical intervention are also at high risk for PTSD.
While birth is usually a happy event, even commonplace experiences of birth may be frightening or trigger painful emotions. Many patients have experienced trauma prior to their pregnancy. The sense of vulnerability and physical discomfort experienced during childbirth may recall old memories.
PTSD may not look the same in new parents as the general population. Symptoms of avoidance, intrusive thoughts or flashbacks may present differently when related to birth trauma. Call PEACE for Moms if you wish assistance with scoring and interpreting this survey.
About 20% of patients who present with postpartum depression have bipolar depression. For many of these patients, their first episode of depression or mania occurs postpartum. They may have not previously recognized or presented with symptoms of bipolar disorder. Because antidepressants can worsen symptoms in a patient with bipolar disorder, patients with depression and anxiety should be evaluated for bipolar disorder as well as depression and anxiety.
Obsessive Compulsive Disorder (OCD)
Obsessive ideas, often in the form of frightening images of the baby being harmed, are common in new parents. Some parents will find themselves caught up in these intrusive thoughts. Patients that do not have obsessive compulsive disorder before pregnancy may experience this in the postpartum time frame. PEACE for Moms can help you distinguish between a patient’s intrusive thoughts and delusions associated with postpartum depression.
A patient with intrusive thoughts or repetitive behaviors should receive the FOCI. If the patient’s score is 8 or greater, they would benefit from further assessment for OCD by a mental health professional. Call P4M for additional help.
Given that most patients will refrain from disclosing their use of alcohol and illicit substances, all perinatal patients ought to be screened for alcohol and drug use. If the patient screens positive for a substance issue, the implications of their usage ought to be shared with them. The clinician should determine if the patient is interested in substance treatment. PEACE for Moms can help you determine where to refer your patient, or how to support their sobriety.
Many patients are able to abstain from substance use while they are pregnant, yet relapse after the baby is born. The stresses of new parenthood render patients particularly vulnerable to relapse and overdose and their needs should be addressed as well.