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Pregnancy Depression is missed

Pregnancy depression 'is missed'
Wednesday, 28 February 2007

GPs and midwives need to do more to spot signs of depression in pregnant women and new mothers, a health watchdog has said.

The National Institute for health and Clinical Excellence (NICE) said women with anxiety or eating disorders also need to be identified.

Up to one in seven women experience a mental health disorder at some point in pregnancy or after the birth.

Mental health experts welcomed the new guidance.

They say it might help to increase the number of women who are diagnosed with depression, anxiety, eating disorders and severe mental health conditions such as schizophrenia and bipolar disorder.

Current estimates suggest the figure could be as low as 30%.

'Bad mother' fears
Dr Steve Pilling, a consultant clinical psychologist who worked on the guidance, said there was "very significant under-recognition" of mental health issues in pregnancy.

NICE advises healthcare staff dealing with pregnant women of new mothers to ask three questions during ante or postnatal checks:-

  1. Have you felt down, depressed or hopeless during the last month?
  2. Have you been bothered by having little interest or pleasure in doing things?
  3. Is this something you feel you need or want help with?
The guidance states that women needing psychological treatment should normally be seen within one month and no longer than three months after an initial assessment.

Treatments may include counselling or anti-depressants, with the health worker explaining how medication may affect breastfeeding.

Experts who worked on the guidance said it was important to identify women not seeking help because they feared being seen as a "bad mother".

They warned that leaving mental illness untreated could have consequences for both mother and child, including poor educational performance for the child and anxiety.

Judgement concerns
Dr Gillian Leng, who led the team which compiled the guidance, said: "This is not just about helping women get through the 'baby blues' - we are looking at all types of mental health disorders and distinguishing the ups and downs of everyday life for more serious conditions."

Fiona Shaw, a patient who also helped draft the guidelines, told how she was admitted to a mental health unit after the birth of her second daughter.

She was not eating and was self-harming but had been told by her doctor to either take anti-depressants and stop breastfeeding or just "grin and bear it".

She added: "Many women are concerned they will not be listened to if they come forward, or that they will be judged, or that their condition is not serious enough to warrant help from a healthcare professional."

Paul Farmer, chief executive of mental health charity Mind, said: "We welcome these guidelines, which look to be a very promising start.

"The challenge, as always, will be ensuring that they are implemented."

"Parents deserve the very best support at the start of their child's life. The resources to make these excellent guidelines a reality must be available, otherwise they risk becoming little more than a wish-list."

Margaret Edwards, of the mental health charity Sane, added: "We welcome the recommendation that psychological treatment to be provided at an early stage and urge action to increase access to such therapies, to minimise the need for medication during pregnancy."
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