#PPDChat Topic 03.31.14: Every Mother, Every Time with @WalkerKarraa


Join us tonight as we discuss why every mother should be screened for perinatal mood disorders (both during pregnancy and postpartum). Dr. Walker Karraa has started a petition at whitehouse.gov and we encourage you to sign it to support every mother’s right to good mental health (and access to treatment) when she needs it most. See you tonight at 830pm ET, 530pm PT.


Breast Cancer, Diabetes screening worth it; Postpartum Depression screening not

Earlier this week, I wrote about UK researchers concluding that Postpartum Depression screening was just not cost effective.

Since then, a couple of other studies regarding screening for other conditions have been released.

It seems that screening for Diabetes in primary care qualifies as cost-effective.

And screening for Breast Cancer saves lives despite the habitual over-diagnosis. For every misdiagnosed case, two lives are saved. In fact, the researchers for this study state that approximately 6 women are misdiagnosed and undergo unnecessary treatment for cancer they may never have developed as a result of a false positive at the screening level. In case you were wondering, these researchers are UK based as well.

Hey. Wait.

The researchers from the UK cited over-diagnosis  as one of the reasons formal screening for Postpartum Depression was not cost effective.

And being misdiagnosed with Postpartum Depression does not lead to expensive radiation treatment or other damaging exposures including surgery. At very worst, you may receive a script for an anti-depressant or a referral to a counselor for some talk therapy.

What the….

So lemme get this straight.

Pumping a woman full of radiation and chemotherapy is hunky dory and cost effective EVEN if she doesn’t need it.

But a quick questionnaire to check on mom’s mental health is NOT?

On what planet does this even BEGIN to make sense??

Let’s also discuss this little nugget. For both the Diabetes and Breast Cancer studies, ACTUAL records were used. The Postpartum Study was compromised of 92 “hypothetical” cases.

When did we stop rating the study of actual records? When did researchers stop including the actual risks and ripples of Postpartum Depression? A woman without Postpartum Depression or who is successfully diagnosed, treated, and recovering is more likely to breastfeed in my opinion. And if she’s nursing, she’s protecting herself and her child from – guess what – Diabetes AND Cancer.

So you really want to practice cost-effective healthcare?

SCREEN women after birth. Ensure their stability, support, and positive outcome with life as a new mom. Encourage them to participate in health practices for themselves and their children. Enabling women to make healthier choices reduces the risk of other issues down the road. Screening saves lives when it comes to Postpartum Mood Disorders. It saves mothers, children, and families. It’s not something you skip over because it’s simply not “cost-effective.” Skip screening and cost will simply shift elsewhere – to diabetes care, cancer care, future mental health care for mom or kids, broken families, etc.

It is simply not acceptable to allow new mothers to continue to suffer. Not acceptable at all.

US Practitioners confident in use of EPDS; not charting results

A study entitled “Universal Screening for Postpartum Depression: an inquiry into provider attitudes and practice”, presented January 2009 at the 29th Annual Meeting of the Society for Maternal Fetal Medicine, January 2009, evaluated usage of the EPDS in an academic based clinical center and also evaluated the practitioner’s knowledge of and attitude towards the EPDS.

A total of 512 records were studied with a rather large difference between percentage of documented screens and reported rates of confidence and knowledge of screening. Only 39% of records included notated screens, 35% charted counseling with patients about their results,  even though 94% of practitioners reported they are responsible for and comfortable with making a diagnosis of a Postpartum Mood Disorder.

The study’s authors concluded that even though practitioners are confident they are not charting the results.

What does this mean?

Either practitioners are not as confident as they claim and really are not screening at a higher suspected level or they are truly confident and not documenting the patient’s complete visit. Whatever the case may be, something needs to change. Increased documentation of Postpartum Mood Disorders would allow for better understanding of how many women really do suffer. It also raises the question if more women than we think are seeking treatment and this information is just not making into the documentation. But at least these practitioners are asking the questions and not wording their way out of it much like a recent UK based study, right?