Perinatal Mental Health Exam With Complete Answers
Definitions:
- PMAD: ✔️ A perinatal mood and anxiety disorder (not just postpartum depression!).
- Perinatal Period: ✔️ Time from conception through the 1st year after giving birth.
- Prenatal or Antenatal Time: ✔️ During pregnancy.
- Postpartum or Postnatal Time: ✔️ The 1st year after giving birth.
Detailed Explanation:
- What does PMAD mean?: ✔️ Perinatal mood (depression, bipolar, psychosis) and anxiety (OCD, panic,
GAD, PTSD) disorders that impact daily functioning. These can occur at any time in life but are
associated with an increased risk during the perinatal period, and symptoms may present uniquely.
Statistics:
- Annual Births to Depressed Mothers: ✔️ Approximately 400,000, making perinatal depression the
most underdiagnosed obstetric complication in America.
- Affected Population:
- ✔️ 1 in 7 women are affected by perinatal depression.
- ✔️ 1 in 10 men are affected by perinatal depression.
- Percentage of Pregnancy Conditions:
- ✔️ 6-8% Pregnancy-Induced Hypertension (PIH)
- ✔️ 6-8% Pre-eclampsia
- ✔️ 6% Gestational Diabetes
- ✔️ 21% PMADs
- Unplanned Pregnancies: ✔️ 50% of pregnancies are unplanned.
Risks of Untreated PMADs:
- Relationship problems
- Poor adherence to medical care
,- Exacerbation of chronic medical issues
- Loss of financial resources
- Disability
- Child neglect/abuse
- Developmental delays
- Increased use of tobacco/alcohol/drugs
- Potential for suicide or homicide
Etiology of Postpartum Depression (PPD):
- Genetic predisposition
- Biological sensitivity to hormonal changes
- Social/environmental factors (history of trauma, poor social support)
- Psychological aspects (relationship with own mother, self-image, perfectionism)
Cultural Considerations:
- In some cultures, mothers may not feel safe to express their needs or seek help.
- Symptoms may be reported differently based on cultural perspectives.
Landmark Study on PPD:
- ✔️ 22% of women had depression during the first year postpartum.
- 26% started before pregnancy
- 33% developed during pregnancy
- 40% experienced it postpartum
- Of the 22% of postpartum mothers:
- ✔️ 68% had unipolar depression
- ✔️ 66% had Major Depressive Disorder (MDD) or a combination with Generalized Anxiety Disorder
(GAD)
- ✔️ 22% had bipolar depression
- ✔️ 19% had thoughts of self-harm
,Relapse Rates:
- Prenatal Depression Relapse Rates:
- ✔️ 26% of those who continued medication relapsed during pregnancy.
- ✔️ 68% of those who stopped medication relapsed.
Percent of fathers with PPD? ✔️10%
Depression in men: timing, symptoms ✔️Peaks at 3-6 months postpartum
May not be sad "masked" and irritable, aggressive, hostile, acting out, checked out, distractions
Do men seek help for their depression? ✔️Not often. Only 3% sought help.
Men are likely to under report symptoms
Single mothers vs single fathers ✔️Single mothers: higher risk of maltreatment. Twice as likely than
mothers with partners to have depression.
Single fathers: have 3 times mortality rate than single mothers or partnered parents.
Trans gestational parents ✔️Needs research to determine prevalence. Baseline depression and anxiety
higher than adult average already.
Other people at risk ✔️Non-gestational parents also at risk for PMADs.
Pregnancy VS Depression ✔️Pregnancy-tearful, labor. No change in self esteem. Sleep disrupted due to
bladder. No SI. Tire but rest restores, appropriate worry, joy, increase appetite
, Depression: irritable, gloom, rage, low self esteem/guilt. Sleep changes, SI. Fatigue and no restoration of
rest. Anhedonia
Characteristics of baby blues ✔️60-80% new moms affected
Due to hormone fluctuation/sleep deprivation
Lasts 2 days-2 weeks. Peaks 3-5 d.
Symptoms of baby blues ✔️Tearfulness, liability, exhaustion
Predominately happy, self esteem unchanged
Unrelated to stress or prior psych history
Consider timing, onset, severity, duration, chronicity when differentiation between PPD and baby blues
Major unipolar depression with peripartum onset DSM criteria ✔️5 or more symptoms present for at
least 2 weeks
Depressed mood most of day
Loss of interest/joy
Weight change or appetite disturbance
Sleep disturbance
Psychomotor agitation
Fatigue
Poor focus
Worthless feelings
Definitions:
- PMAD: ✔️ A perinatal mood and anxiety disorder (not just postpartum depression!).
- Perinatal Period: ✔️ Time from conception through the 1st year after giving birth.
- Prenatal or Antenatal Time: ✔️ During pregnancy.
- Postpartum or Postnatal Time: ✔️ The 1st year after giving birth.
Detailed Explanation:
- What does PMAD mean?: ✔️ Perinatal mood (depression, bipolar, psychosis) and anxiety (OCD, panic,
GAD, PTSD) disorders that impact daily functioning. These can occur at any time in life but are
associated with an increased risk during the perinatal period, and symptoms may present uniquely.
Statistics:
- Annual Births to Depressed Mothers: ✔️ Approximately 400,000, making perinatal depression the
most underdiagnosed obstetric complication in America.
- Affected Population:
- ✔️ 1 in 7 women are affected by perinatal depression.
- ✔️ 1 in 10 men are affected by perinatal depression.
- Percentage of Pregnancy Conditions:
- ✔️ 6-8% Pregnancy-Induced Hypertension (PIH)
- ✔️ 6-8% Pre-eclampsia
- ✔️ 6% Gestational Diabetes
- ✔️ 21% PMADs
- Unplanned Pregnancies: ✔️ 50% of pregnancies are unplanned.
Risks of Untreated PMADs:
- Relationship problems
- Poor adherence to medical care
,- Exacerbation of chronic medical issues
- Loss of financial resources
- Disability
- Child neglect/abuse
- Developmental delays
- Increased use of tobacco/alcohol/drugs
- Potential for suicide or homicide
Etiology of Postpartum Depression (PPD):
- Genetic predisposition
- Biological sensitivity to hormonal changes
- Social/environmental factors (history of trauma, poor social support)
- Psychological aspects (relationship with own mother, self-image, perfectionism)
Cultural Considerations:
- In some cultures, mothers may not feel safe to express their needs or seek help.
- Symptoms may be reported differently based on cultural perspectives.
Landmark Study on PPD:
- ✔️ 22% of women had depression during the first year postpartum.
- 26% started before pregnancy
- 33% developed during pregnancy
- 40% experienced it postpartum
- Of the 22% of postpartum mothers:
- ✔️ 68% had unipolar depression
- ✔️ 66% had Major Depressive Disorder (MDD) or a combination with Generalized Anxiety Disorder
(GAD)
- ✔️ 22% had bipolar depression
- ✔️ 19% had thoughts of self-harm
,Relapse Rates:
- Prenatal Depression Relapse Rates:
- ✔️ 26% of those who continued medication relapsed during pregnancy.
- ✔️ 68% of those who stopped medication relapsed.
Percent of fathers with PPD? ✔️10%
Depression in men: timing, symptoms ✔️Peaks at 3-6 months postpartum
May not be sad "masked" and irritable, aggressive, hostile, acting out, checked out, distractions
Do men seek help for their depression? ✔️Not often. Only 3% sought help.
Men are likely to under report symptoms
Single mothers vs single fathers ✔️Single mothers: higher risk of maltreatment. Twice as likely than
mothers with partners to have depression.
Single fathers: have 3 times mortality rate than single mothers or partnered parents.
Trans gestational parents ✔️Needs research to determine prevalence. Baseline depression and anxiety
higher than adult average already.
Other people at risk ✔️Non-gestational parents also at risk for PMADs.
Pregnancy VS Depression ✔️Pregnancy-tearful, labor. No change in self esteem. Sleep disrupted due to
bladder. No SI. Tire but rest restores, appropriate worry, joy, increase appetite
, Depression: irritable, gloom, rage, low self esteem/guilt. Sleep changes, SI. Fatigue and no restoration of
rest. Anhedonia
Characteristics of baby blues ✔️60-80% new moms affected
Due to hormone fluctuation/sleep deprivation
Lasts 2 days-2 weeks. Peaks 3-5 d.
Symptoms of baby blues ✔️Tearfulness, liability, exhaustion
Predominately happy, self esteem unchanged
Unrelated to stress or prior psych history
Consider timing, onset, severity, duration, chronicity when differentiation between PPD and baby blues
Major unipolar depression with peripartum onset DSM criteria ✔️5 or more symptoms present for at
least 2 weeks
Depressed mood most of day
Loss of interest/joy
Weight change or appetite disturbance
Sleep disturbance
Psychomotor agitation
Fatigue
Poor focus
Worthless feelings
