PSI Perinatal Mental Health Certification Exam
(2026/2027) QUESTIONS WITH ANSWERS GRADED
A+
• James A. Hamilton, MD, PhD -✓✓ 20th century's father of postpartum psychiatric
illness; co-founder of the marce society; advocate of research, treatment and social
support movement
• when did DSM include postpartum onset specifier? -✓✓ 1994, DSM-IV
• how many infants are born to depressed mothers? -✓✓ 800K
• what is the most underdiagnosed obstetric complication in the US? -✓✓ perinatal
mood anxiety disorders (21%)
• cost of untreated PMADs (10) -✓✓ 1) impacting medical care
2) child abuse and neglect,
3) discontinuation of breastfeeding,
4) family dysfunction/relationship problems,
5) IPV/separation/divorce,
6) loss of interpersonal and financial resources,
7) disability/unemployment,
8) adversely affects early brain development/developmental delays/behavior problems,
9) tobacco, alcohol and substance use,
10) infanticide/homicide/suicide,
• what percentage of women with PMADs get the treatment they need? -✓✓ 50%
• biological etiology of PMADs -✓✓ biological sensitivites to hormonal changes
-increase in estrogen and progesterone
-onset of oxytocin and prolactin at time of birth
-estrogen and progresterone crash down after birth
• increase of estrogen in pregnancy -✓✓ to improve formation of blood vessels, transfer
of nutrients, supply fetal development
• increase of progesterone in pregnancy -✓✓ uterine development, ligament and joint
flexibility
• biological risk factors for PMADs -✓✓ 1) endocrine dysfunction - diabetes, hx of thyroid
imbalance, fertility challenges, other endocrine disorders (PMDD, PCOS)
2) significant mood reactions to hormonal changes - puberty, PMS, hormonal birth
control; abrupt discontinuation of breast feeding; physical pain and/or inflammation
, 3) lack of sleep
• psychological etiology for PMADs -✓✓ 1) vulnerability (sleep, genetic predisposition);
2) psychological (relationship with own mother, ambivalence to parenthood, self-
image/perfectionsm); 3) social/environmental (history of trauma, poor social support,
institutional/structural racism)
• psychological risk factors for PMADs -✓✓ - family or personal history of previous
PMADs
- family or personal history of depression, anxiety, OCD, eating disorder, bipolar
disorder, etc
- hx of CSA
-inadequate partner/social support
-interpersonal violence
-financial stressors/poverty
-childcare stressors
-recent loss or move
-barriers to care/institutional racism
-climate stressors: seasonal depression or mania
-complications in pregnancy, birth or breastfeeding
-health challenges in baby or parents
-temperament of baby
-returning to work
-unresolved grief or loss
• highest prevalence rates for PMADs based on race -✓✓ hispanic women, black
women, american indian, asian american
• strongest predictor of paternal depression -✓✓ maternal PMAD increased the risk
more than father's own history of depression
• topics for discussion with trans/non-binary parents -✓✓ - gender affect from body
feeding, top surgery options, accessing lactation care as a transmasculine person,
deciding when to restart T
• baby blues -✓✓ -affects up to 80% new mothers; due to hormone fluctuation at the
time of birth and acute sleep deprivation
- lasts 2 days-2weeks after birth
-peaks 3-5 days after delivery
-symptoms: tearfulness, lability, reactivity, exhaustion
-predominantly happy, unrelated to stress or prior psych hx
• When does DSM-5 specify peripartum onset? -✓✓ in pregnancy, or within 4 weeks
following birth
(2026/2027) QUESTIONS WITH ANSWERS GRADED
A+
• James A. Hamilton, MD, PhD -✓✓ 20th century's father of postpartum psychiatric
illness; co-founder of the marce society; advocate of research, treatment and social
support movement
• when did DSM include postpartum onset specifier? -✓✓ 1994, DSM-IV
• how many infants are born to depressed mothers? -✓✓ 800K
• what is the most underdiagnosed obstetric complication in the US? -✓✓ perinatal
mood anxiety disorders (21%)
• cost of untreated PMADs (10) -✓✓ 1) impacting medical care
2) child abuse and neglect,
3) discontinuation of breastfeeding,
4) family dysfunction/relationship problems,
5) IPV/separation/divorce,
6) loss of interpersonal and financial resources,
7) disability/unemployment,
8) adversely affects early brain development/developmental delays/behavior problems,
9) tobacco, alcohol and substance use,
10) infanticide/homicide/suicide,
• what percentage of women with PMADs get the treatment they need? -✓✓ 50%
• biological etiology of PMADs -✓✓ biological sensitivites to hormonal changes
-increase in estrogen and progesterone
-onset of oxytocin and prolactin at time of birth
-estrogen and progresterone crash down after birth
• increase of estrogen in pregnancy -✓✓ to improve formation of blood vessels, transfer
of nutrients, supply fetal development
• increase of progesterone in pregnancy -✓✓ uterine development, ligament and joint
flexibility
• biological risk factors for PMADs -✓✓ 1) endocrine dysfunction - diabetes, hx of thyroid
imbalance, fertility challenges, other endocrine disorders (PMDD, PCOS)
2) significant mood reactions to hormonal changes - puberty, PMS, hormonal birth
control; abrupt discontinuation of breast feeding; physical pain and/or inflammation
, 3) lack of sleep
• psychological etiology for PMADs -✓✓ 1) vulnerability (sleep, genetic predisposition);
2) psychological (relationship with own mother, ambivalence to parenthood, self-
image/perfectionsm); 3) social/environmental (history of trauma, poor social support,
institutional/structural racism)
• psychological risk factors for PMADs -✓✓ - family or personal history of previous
PMADs
- family or personal history of depression, anxiety, OCD, eating disorder, bipolar
disorder, etc
- hx of CSA
-inadequate partner/social support
-interpersonal violence
-financial stressors/poverty
-childcare stressors
-recent loss or move
-barriers to care/institutional racism
-climate stressors: seasonal depression or mania
-complications in pregnancy, birth or breastfeeding
-health challenges in baby or parents
-temperament of baby
-returning to work
-unresolved grief or loss
• highest prevalence rates for PMADs based on race -✓✓ hispanic women, black
women, american indian, asian american
• strongest predictor of paternal depression -✓✓ maternal PMAD increased the risk
more than father's own history of depression
• topics for discussion with trans/non-binary parents -✓✓ - gender affect from body
feeding, top surgery options, accessing lactation care as a transmasculine person,
deciding when to restart T
• baby blues -✓✓ -affects up to 80% new mothers; due to hormone fluctuation at the
time of birth and acute sleep deprivation
- lasts 2 days-2weeks after birth
-peaks 3-5 days after delivery
-symptoms: tearfulness, lability, reactivity, exhaustion
-predominantly happy, unrelated to stress or prior psych hx
• When does DSM-5 specify peripartum onset? -✓✓ in pregnancy, or within 4 weeks
following birth
