Identifying Perinatal Depression and Anxiety E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 724

Veröffentlichungsjahr: 2015

Beschreibung

Identifying Perinatal Depression and Anxiety brings together the very latest research and clinical practice on this topic from around the world in one valuable resource.

• Examines current screening and management models, particularly those in Australia, England and Wales, Scotland, and the United States
• Discusses the evidence, accuracy, and limitations of screening methods in the context of challenges, policy issues, and questions that require further research
• Up to date practical  guidance of how to screen, assess, diagnose and manage is provided.
• Considers the importance of screening processes that involve infants and fathers, additional training for health professionals, pathways to care following screening, and the economics of screening
• Offers forward-thinking synthesis and analysis of the current state of the field by leading international experts, with the goal of sketching out areas in need of future research

Leseprobe

CONTENTS

Cover

Title page

About the Editors

About the Contributors

Foreword

Introduction: Current Issues in Identifying Perinatal Depression

The Screening Conundrum

The Contributed Chapters

Concluding Issues

Final Comments

References

1 Is Population-Based Identification of Perinatal Depression and Anxiety Desirable?

Introduction

Clinical Presentation of Perinatal Depression and Anxiety

Care Continuum

Prevalence and Incidence

Adverse Health Effects

Clinical Recognition

Effective Treatment

Availability of and Barriers to Access of Treatment

Adherence to Best Practices

Discussion

References

2 When Screening Is Policy, How Do We Make It Work?

Introduction

The Basic Questions to Address When Implementing Perinatal Mood Screening Policies

References

3 Acceptability, Attitudes, and Overcoming Stigma

Introduction

Acceptability of Screening

Health-Care Provider Attitudes

Barriers to Seeking Treatment

Steps Forward

References

4 How to Use the EPDS and Maximize Its Usefulness in the Consultation Process

Rationale for the Use of Screening Tools to Identify Perinatal Depression and Anxiety

Who Can Use the EPDS?

How to Administer the EPDS

When to Screen with the EPDS

Explaining Screening to Women

Conducting Screening with Women from Culturally and Linguistically Diverse Backgrounds

How to Score and Interpret EPDS Results

How to Interpret the Anxiety Subscale

How to Explain Screening Results to Women

How to Respond to Question 10: Risk Assessment

Conclusions

References

5 Screening Tools and Methods of Identifying Perinatal Depression

Introduction

EPDS

Generic Self-Report Instruments

Other Perinatal-Specific Self-Report Instruments

Clinician-Rated Scales

Case-Finding Perinatal Depression

Screening Tools for Culturally Diverse Populations

Conclusion

References

6 Identifying Perinatal Anxiety

Why Is It Important to Identify Perinatal Anxiety?

Prevalence

Relevance of Standard Diagnostic Criteria to Perinatal Women

Issues to Consider When Measuring Perinatal Anxiety

Diagnostic Interviews to Assess Anxiety

Questionnaire Measures of Anxiety

Pregnancy-Specific Measures of Anxiety

Whether to Measure Anxiety or General Distress

Conclusion and Recommendations

References

7 Diagnostic Assessment of Depression, Anxiety, and Related Disorders

Perinatal Mood and Anxiety Disorders in the Current Diagnostic Systems

Diagnostic Challenges

Differential Diagnosis

Clinical Evaluation and Diagnostic Tools

Summary and Conclusions

References

8 Psychosocial Assessment and Integrated Perinatal Care

Background

Definitions Relevant to Integrated Psychosocial Assessment

The Debate: For and against Psychosocial Assessment

Psychosocial Assessment Tools for Clinicians

Principles for Establishing an Integrated Psychosocial Assessment Program in the Primary Health-Care Setting

Integrated Psychosocial Assessment Program in the Maternity Setting: An Example

Integrated Perinatal Care for Women Living in Resource-Constrained Settings

Future Directions and Developing the Evidence Base

Acknowledgments

References

9 Postnatal Depression, Mother–Infant Interactions, and Child Development

Overview

Effects of Postnatal Depression on Mother–Child Relationships

Effects of PND on Biological Outcomes

Effects of PND on Cognitive Development

Effects of PND on Behavioral, Socioemotional, and Psychiatric Problems

Treatment

Summary

References

10 Fathers’ Perinatal Mental Health

Introduction

Depression in Fathers

Fathers’ Anxiety

Sad Dads: Influence on Children and Families

Screening Fathers for Depression and Anxiety

Acceptability and Engagement

Innovations for Addressing Fathers with Perinatal Depression

Conclusions

References

11 Evidence-Based Treatments and Pathways to Care

Psychological Interventions

Prevention of Postnatal Depression

Pharmacological Treatment

CAM

Pathways to Care

Conclusions

References

12 International Approaches to Perinatal Mental Health Screening as a Public Health Priority

Introduction

Synthesis and Discussion

Acknowledgment

References

13 Training Health-Care Professionals for the Assessment and Management of Perinatal Depression and Anxiety

Introduction

Strategies for Effective Training of Health-Care Professionals

Trainers

The Context of Training

Training Aims

Training to Develop Perinatal Screening Skills

Assessing Risk

Training HVs in the PoNDER Trial

The Australian NPDI

Multidisciplinary Training: The Management of Training Programs

Summary

Conclusions

Appendix 13.A

References

14 An Overview of Health Economic Aspects of Perinatal Depression

Introduction

An Overview of Health Economic Methods

Economic Costs Associated with Perinatal Depression

CE of Prevention Strategies

CE of Identification Strategies

CE of Treatment Strategies

Future Research Directions

Conclusions

Acknowledgments

References

15 The Future of Perinatal Depression Identification

Introduction

Outline of the Chapter

Online Screening for Perinatal Depression

Overcoming Poor Screening Practices through Technology-Based Decision Support Systems

New Developments: Innovative Information Technologies

Internet-Based Interventions for Perinatal Depression

Final Remarks

Future Directions

References

16 Conclusion

Our Own Journey So Far

Which Way Forward?

Editors’ Acknowledgments

References

Index

End User License Agreement

List of Tables

Chapter 02

Table 2.1 Questions to answer before implementing perinatal depression screening

Table 2.2 Comparison of characteristics of PND screening tools

Table 2.3 Summary of evidence-based recommendations for PND screening

Chapter 05

Table 5.1 Generic self-report instruments

Chapter 07

Table 7.1 DSM-5 criteria for a major depressive episode. Changes from DSM-IV are highlighted in bold and described in the right column. Compared to the previous version, DSM-5 contains a broader definition of major depression, including hopelessness as a core symptom and depression only 2 weeks after bereavement

Chapter 08

Table 8.1 Psychosocial assessment: Practice summary

Chapter 10

Table 10.1 Comparison of EPDS and GMDS questionnaire items

Chapter 12

Table 12.1 Current clinical practice guidelines: approach, main elements of care models and psychosocial assessment

Table 12.2 Extract from the Woman-Held Maternity Record (Scotland)

List of Illustrations

Chapter 01

Figure 1.1 Care continuum for perinatal depression and anxiety.

Figure 1.2 Perinatal depression care continuum. Recognized clinically: prenatal, 41% (Goodman & Tyer-Viola, 2010); postpartum, 29% (Heneghan, Silver, Bauman, & Stein, 2000) to 43% (Hearn et al., 1998). Best-case scenario, 40%. Any treatment: prenatal, 58% of those identified received treatment in clinic or accepted referral to mental health in well-educated, high SES setting (27/46); postpartum, 82% (9/11) in well-educated, high SES setting. In general, in primary care nonpsychiatric settings (high and low SES), 50% (Pence et al., 2012). Average, 60%. Adequate treatment, 40% (likely best-case scenario) for depression care in a nonspecialty mental health setting (Pence et al., 2012). Achieved remission, 30% (in real-world primary care setting following aggressive treatment) (Trivedi et al., 2006) to 66% (in clinical trials) (Gloaguen et al., 1998).

Chapter 02

Figure 2.1 (a) Example of Immediate Action Protocol (IAP) for suicidal ideation evaluation. (b) Diagnosis and follow-up of postpartum depression for intervention practices. (This is box inset of Figure 2.1a.).

Chapter 13

Figure 13.1 Mean EPDS scores for “at-risk” women (with a 6-week EPDS score ≥ 12) and for “all” women in the PoNDER trial from 6 weeks to 12 months postnatally.

Chapter 14

Figure 14.1 The cost-effectiveness plane. NW, denotes northwest; NE, denotes northeast; SW, denotes southwest; SE, denotes southeast.

Chapter 16

Figure 16.1 Timeline of the National Perinatal Depression Initiative (NPDI) in Australia. The Initiative involves psychosocial assessment, including depression screening, for every perinatal woman at least once in pregnancy and at least once in the first year postpartum.

Guide

Cover

Table of Contents

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Identifying Perinatal Depression and Anxiety

Evidence-Based Practice in Screening, Psychosocial Assessment, and Management

Edited by

Jeannette Milgrom and Alan Gemmill

This edition first published 2015© 2015 John Wiley & Sons, Ltd.

Registered OfficeJohn Wiley & Sons, Ltd., The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

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Library of Congress Cataloging-in-Publication Data

Identifying perinatal depression and anxiety : evidence-based practice in screening, psychosocial assessment and management / edited by Jeannette Milgrom, Alan W. Gemmill.      p. ; cm.   Includes bibliographical references and index.

   ISBN 978-1-118-50965-4 (hb) – ISBN 978-1-118-50969-2 (pb)I. Milgrom, Jeannette, editor.   II. Gemmill, Alan, editor.[DNLM:   1. Depression, Postpartum–diagnosis.   2. Anxiety Disorders–diagnosis.   3. Anxiety Disorders–psychology.   4. Depression, Postpartum–psychology.   5. Evidence-Based Medicine–methods.   6. Internationality. WQ 500]   RC537   616.85′27–dc23

         2014048416

A catalogue record for this book is available from the British Library.

Cover image: Cracked White Marble © LordRunar / iStockphoto; Vector silhouette of family © majivecka / iStockphoto

About the Editors

Alan W. Gemmill is Senior Research Fellow at the Parent-Infant Research Institute in Melbourne, Australia. He has worked in perinatal mental health research for 14 years and has a special interest in clinical research studies and preventive intervention programs for maternal mental health difficulties. He has had a lead role in several randomized treatment trials for perinatal depression and has published widely on such topics as the neurodevelopmental benefits of early stress reduction for premature infants, the prevention of perinatal mood disorders and parenting difficulty, the major risk factors for perinatal depression and anxiety, and the predictive value of screening instruments for perinatal mood disorders.

Jeannette Milgrom is Professor of Psychology in the Melbourne School of Psychological Sciences at the University of Melbourne, Director of Clinical and Health Psychology at Austin Health, and Founder and Director of the Parent-Infant Research Institute, Australia. She is internationally recognized for her work with mothers and babies and is currently President of the Marcé Society for Perinatal Mental Health. She is the author of six books, and over 116 scientific articles and chapters. Her research and clinical practice focuses on high-risk infants and early intervention, ante- and postnatal depression, neurodevelopment of premature infants, and screening and developing psychological treatments. Her books on treating and preventing postnatal depression have been translated into Italian and French. She has had a major role with beyondblue and the National Perinatal Depression Initiative since 2001.

About the Contributors

Marie-Paule Austin is the chair of Perinatal and Women’s Mental Health at the University of New South Wales; director at St John of God Health Care Mother–Baby Unit; and psychiatrist at the Royal Hospital for Women, Sydney. Professor Austin has long been at the forefront of research into models of universal psychosocial assessment in the perinatal period, and both her clinical and population-based researches have been instrumental in shaping the development of policy and practice in perinatal mental health across Australia.

Susan Ayers is a professor in the Centre for Maternal and Child Health Research at City University London and visiting professor at the University of Sussex, United Kingdom. Susan’s research focuses on women’s psychological well-being and mental health during pregnancy and after birth. Susan is an author of Psychology for Medicine (2011) and editor of the Cambridge Handbook of Psychology, Health and Medicine, 2nd Ed. (2007). She was awarded the Annual Lecturer Prize by the Society for Reproductive and Infant Psychology in 2012.

Susan L. Bertram, BSN RN MSN, is trained as a psychiatric clinical nurse specialist. She has worked as a lead study coordinator for the past 20 years with Dr. Barbara Yawn in the Olmsted Medical Center, Department of Research. She served as the lead coordinator and project manager for the recently completed TRIPPD 5-year trial assessing the outcomes of implementing postnatal depression screening, diagnosis, and management in family medicine offices.

William V. Bobo, MD MPH, is a psychiatrist and researcher, associate professor of psychiatry at the Mayo Medical School, and medical director of the Mayo Clinic Mood Program. His research is focused on the effectiveness, safety, and clinical use of treatments for severe mood disorders. Dr. Bobo has special interest in the perinatal management of these disorders and use of psychotropic medications during pregnancy.

Angela Bowen, RN, PhD, is an associate professor in the College of Nursing and the Department of Psychiatry at the University of Saskatchewan. Recent research includes a longitudinal study and epidemiological study of antenatal depression in progress, evaluation of maternal mental health programs, and policy development. She is the lead of the Maternal Mental Health Strategy group, which developed and is implementing policy recommendations to address antenatal and postpartum depression (PPD) in Saskatchewan, Canada.

Anne Buist, MBBS, MMed, MD, FRANZCP, is the professor/director of Women’s Mental Health at the University of Melbourne and Austin Health and has clinical and research experience in perinatal mental illness, its association with childhood abuse, and long-term outcomes. She led the beyondblue Postnatal Depression Program that resulted in screening implementation throughout Australia.

Rose Coates is a doctoral researcher in the School of Psychology, University of Sussex, United Kingdom. Her research is on optimal ways of conceptualizing and screening for postnatal psychological distress such as anxiety, depression, and posttraumatic stress following birth. She has published on anxiety measurement, symptoms of perinatal distress, and intervention.

Roch Cantwell is a consultant perinatal psychiatrist with Greater Glasgow and Clyde Health Board, United Kingdom, and honorary senior clinical lecturer at Glasgow University. He is past chair of the RCPsych Perinatal Section and lead psychiatric assessor for the UK Confidential Enquiries into Maternal Deaths. He chaired the SIGN Perinatal Mood Disorders Guideline Development Group and was joint author of the RCOG Good Practice Guideline on Mental Health Issues in Pregnancy.

Peter Cooper is a research professor in psychopathology at the University of Reading and codirector, with Lynne Murray, of the Winnicott Research Unit. He is also professor extraordinaire at Stellenbosch University in South Africa. He has conducted epidemiological, experimental, longitudinal, and intervention research in a range of areas, including eating disorders, depression, and child anxiety. His current work, in collaboration with Lynne Murray, principally concerns the development and evaluation of early interventions to improve child outcomes in the developing world. He is the editor of the Constable & Robinson Overcoming series of self-help books for psychological disorders.

Jan Cubison is a clinical service manager, Sheffield Perinatal Mental Health Service. Jan provided the introductory day health visitor training for the PoNDER trial. Research outputs include screening for postnatal depression in primary care, in Screening for Perinatal Depression (eds C. Henshaw and S. Elliott, 2005), and Thoughts of infanticide (Marcé International Conference, September 2006). Expert advisory work includes independent inquiry on Daksha Emson (2003); NICE Guidelines, Pregnancy and complex social factors (2010); Service user experience in adult mental health (2011); and NHS England, Clinical Reference Group for specialized perinatal mental health services (current).

Dr. Pim Cuijpers is a professor of clinical psychology at the VU University Amsterdam (the Netherlands) and head of the Department of Clinical Psychology. Since 2009, he has published more than 475 papers, chapters, reports, and professional publications, including more than 300 papers in peer-reviewed international scientific journals.

Dr. Brian Danaher is a senior research scientist at Oregon Research Institute (Eugene, OR, United States). Recent grant-funded research projects and publications have focused on development and evaluation of technology-delivered behavioral interventions (including use of web and mobile phone methods) for treatment of tobacco and postnatal depression.

Cindy-Lee Dennis is a professor of nursing and psychiatry at the University of Toronto and a senior scientist at Women’s College Research Institute. She simultaneously holds the Canada Research Chair in Perinatal Community Health and the Shirley Brown Chair in Women’s Mental Health Research. She has published widely in the area of perinatal depression and has completed five Cochrane systematic reviews. Her research focuses on evaluating telephone-based interventions for the prevention and treatment of PPD.

Arianna Di Florio is a clinical research fellow at the Department of Psychological Medicine and Clinical Neurosciences at Cardiff University (United Kingdom). After obtaining her undergraduate qualification in medicine at the University of Padua (Italy), she specialized in psychiatry. She completed her PhD at Cardiff University with a thesis on bipolar disorder in pregnancy and postpartum. She has recently been awarded a Marie Curie International Outgoing Fellowship to visit the Center for Women’s Mood Disorders at the University of North Carolina at Chapel Hill (United States), where she will develop predictive models for postnatal depression and psychosis.

Dr. Tara Donker is a research fellow at the Black Dog Institute, University of New South Wales, Australia. Her research areas include online screening, early intervention, and prevention of depression, anxiety, and suicide, with a special interest in e-mental health.

Jennifer Ericksen is a clinical psychologist and manager of Perinatal Mental Health Services and Training, Parent–Infant Research Institute, Austin Health. The institute is a large treatment center for perinatal depression and anxiety specializing in developing and evaluating clinical interventions. She also provides professional development sessions to maternal and child health nurses, psychologists, general practitioners and midwives. She has contributed to many intervention programs and academic publications.

Jonathan Evans is a senior lecturer, University of Bristol, Bristol, UK, and honorary consultant psychiatrist. His research has focused on parental depression and consequences for offspring particularly using data from the Avon Longitudinal Study of Parents and Children. He has a particular interest in identifying and treating depression during pregnancy and has conducted one of the few randomized trials for antenatal depression.

Pasco Fearon is a professor of developmental psychopathology at University College London (UCL) and joint director of UCL’s doctoral training program in clinical psychology. He is a developmental and clinical psychologist, and his research focuses on the role of relationships in early child development. His work integrates social and biological perspectives, particularly the role of parenting and attachment on the one hand and genetics and physiology on the other.

Jane Fisher is a professor of women’s health and the director of the Jean Hailes Research Unit in the School of Public Health and Preventive Medicine at Monash University. She is an academic clinical and health psychologist with long-standing interests in public health perspectives on the links between women’s reproductive health and mental health including during pregnancy, birth, and the postpartum period. She has been consultant clinical psychologist to Masada Private Hospital Mother–Baby Unit since 1996.

Richard Fletcher, PhD, is a senior lecturer in the Family Action Centre, Faculty of Health, the University of Newcastle, NSW, and convenor of the Australian Fatherhood Research Network. He is currently researching the effects of paternal play on children’s self-regulation and video-feedback processes for addressing father–infant and father–child attachment and identifying practice and policy components to reduce paternal perinatal depression. His book The Dad Factor has been translated into Spanish, Korean, German, and Chinese.

Megan Galbally is a consultant psychiatrist and head of unit, Perinatal Mental Health, at Mercy Hospital for Women and a clinical associate professor in the Department of Obstetrics and Gynaecology, University of Melbourne. Dr Galbally’s research focus is on the effects of exposure to maternal mental illness and pharmacological treatments in pregnancy on pregnancy, neonatal, and child developmental outcomes.

Craig F. Garfield, MD, MAPP, is an associate professor at the Northwestern University Feinberg School of Medicine in the Departments of Pediatrics and Medical Social Sciences. His research focuses on the role families play in optimizing and promoting the well-being of children, with current research projects examining the role of fathers in health care, using technology to support families with children, and the effect of workplace policies on family well-being.

Norma I. Gavin, PhD, is a senior research economist in RTI International’s Division of Health Services and Social Policy Research. Dr. Gavin has more than 30 years of experience in policy analysis and health services research. Her research has focused on the access to and quality of health care for vulnerable populations, particularly low-income pregnant women and children, and includes a widely cited systematic evidence review of the prevalence and incidence of perinatal depression.

Bradley N. Gaynes, MD, MPH, is a professor of psychiatry at the University of North Carolina and the associate chair of Research Training and Education. Dr. Gaynes works at the crossroads between clinical trials research and mental health services research, focusing his clinical and research efforts on mental health–primary care integration and health-care delivery in real-world nonpsychiatric settings. His primary research interests involve assessing and managing depressive illness in primary care settings, HIV settings, and obstetrical/gynecological settings.

Nine M.-C. Glangeaud-Freudenthal, PhD, is a senior researcher in the field of perinatal mental health and is working in an epidemiological research unit on perinatal health and women’s and children’s health. She is a Marcé Society past president and a founder of the Francophone group of this society. She has published papers on PPD and postpartum blues and on the analysis of a 10-year database on mother–baby inpatient units in France, Belgium, and Luxembourg. Nine Glangeaud-Freudenthal wishes to thank and acknowledge Bénédicte Coulm, Christine Rainelli, Michel Dugnat, and Anne Laure Sutter-Dallay for useful discussions and input to the section of Chapter 10 dealing with best-practice guidelines in France.

Vivette Glover, MA, PhD, DSc, is a professor of perinatal psychobiology, Imperial College London. In recent years, Dr. Glover has applied her expertise in biological psychiatry to the problems of mothers and babies. Projects include studies showing maternal prenatal stress increases the probability for a range of adverse neurodevelopmental outcomes for the child. Her group is also studying the underlying biological mechanisms. She has published over 400 papers and been awarded the Marcé Society Medal.

Dr. Pauline Hall is a training coordinator and clinician at the National Perinatal Depression Initiative in South Australia. Research interests include ego-dystonic intrusive thoughts after childbirth and implementation of universal perinatal screening for depression. Publications relevant to this book include Hall, P.L. (2012) (Current considerations of the effects of untreated maternal perinatal depression and the National Perinatal Depression Initiative. Journal of Developmental Origins of Health and Disease 3, 293–295) and Hall, P.L. (2013) (Normalisation of negative thoughts after childbirth. Interaction 31, 9–12).

Carol Henshaw is a consultant in perinatal mental health at Liverpool Women’s Hospital, honorary senior lecturer at the University of Liverpool, and honorary visiting fellow at Staffordshire University, United Kingdom. Her research has focused on the long-term follow-up of postpartum blues and depression and systematic reviews. She has edited, written, and contributed to books on screening for perinatal depression, the Edinburgh Postnatal Depression Scale, and perinatal psychiatry.

Nicole Highet is the Founder and Executive Director of COPE: Centre of Perinatal Excellence, Australia. Nicole has played a significant role in perinatal mental health reform, providing national leadership and advocacy for the establishment and implementation of Australia’s $85M National Perinatal Depression Initiative (NPDI). Nicole has also co-chaired the development of Australia’s first Clinical Practice Guidelines and has had oversight of national and local campaigns and approaches to mental health promotion and stigma reduction.

Ian Jones is a professor of psychiatry and director of the National Centre for Mental Health (www.NCMH.info) at Cardiff University, Wales. He is the director of the Bipolar Education Programme Cymru which was named Innovation in Medicine Team of the Year at the British Medical Journal Awards 2014. His research involves clinical and molecular genetic studies of bipolar disorder and postpartum psychosis. He has authored or coauthored over 200 publications and book chapters in the fields of mood disorder genetics and perinatal psychiatry. He has been awarded the Marcé Medal for his research on postpartum psychosis and was named Academic Psychiatrist of the Year at the RCPsych Awards 2013.

Martin Knapp is an academic researcher working in the areas of health and social care policy and practice. He is now based full time at the London School of Economics and Political Science (LSE), United Kingdom, after also working for more than 20 years as professor of health economics at King’s College London. At LSE, he has been professor of social policy and director of the Personal Social Services Research Unit since 1996. He has also been codirector of LSE Health and Social Care since this overarching center was set up in 2000. Since 2009, he has been director of the School for Social Care Research, funded by the National Institute for Health Research in England. Martin’s research in recent years has mainly been in the areas of mental health, dementia, autism, and long-term care. Most of this work has had a particular focus on economic issues. He has authored or edited 16 books, more than 450 papers in peer-reviewed journals, and many book chapters and reports. His work has fed through to have an impact on policy and practice discussions in the mental health and long-term care areas, both in the United Kingdom and elsewhere.

Elizabeth M. LaRusso, MD, is a perinatal and reproductive psychiatrist at Allina Health and Children’s Hospitals and Clinics of Minnesota. Her clinical work is focused on women with psychiatric issues during the perinatal period and her publications focus on perinatal mood disorders. She is also the director of the Mother–Baby Mental Health Program at Allina Health and Children’s Hospitals and Clinics of Minnesota.

Rachel Mann, research fellow, University of York, York, UK, has a background in nursing and completed her PhD in health sciences at the University of York on the validity and acceptability of case-finding questions to identify perinatal depression. She has worked on two mental health projects including an HTA-funded review of screening for postnatal depression in primary care. Prior to joining the University of York, she was a visiting scholar at the global headquarters of Merck & Co., Inc., United States.

Stephen Matthey is a senior clinical psychologist and researcher in the Department of Health in NSW, Australia. He is also an adjunct associate professor in the School of Psychology, University of Sydney, Australia (but note: I’m English!). He has published around 100 papers in peer-reviewed journals on a range of topics, including child and adult treatment, educational psychology, cross-cultural psychology, perinatal mental health, psychological assessment, questionnaire development, statistics, brain injury, fathers, parenting programs, and the evaluation of clinical services. He loves playing football, riding his motorbike, learning Italian, and playing the violin.

Jennifer E. McCabe is a graduate student at the University of Iowa. She is a doctoral candidate in the clinical psychology program under the advisement of Dr. Michael O’Hara. Her research broadly pertains to the effects of maternal mental health on mother–child interactions and child development. She has a particular interest in maternal “distress tolerance” and its impact on the developing mother–child relationship.

Samantha Meltzer-Brody, MD, MPH, is an associate professor and director of the Perinatal Psychiatry Program of the UNC Center for Women’s Mood Disorders. Her research is focused on pathophysiological and genetic models of PPD and lactation failure, and she has established an international PPD genetics consortium examining the biomarker signature of PPD. Dr. Meltzer-Brody maintains an active clinical practice in perinatal psychiatry and has published numerous manuscripts on women’s reproductive mood disorders.

Dr. C. Jane Morrell is associate professor in health research, University of Nottingham, United Kingdom. She was principal investigator in randomized controlled trials and economic evaluations examining the cost-effectiveness of postnatal social support and examining the cost-effectiveness of training health visitors in the prevention and management of postnatal depression (the PoNDER trial). Jane is chief investigator for the National Institute for Health Research, Health Technology Assessment 11/95/03, “Evidence synthesis, meta-analysis and decision analytic modelling following a systematic review of quantitative and qualitative studies evaluating the effectiveness, cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression.”

Lynne Murray is research professor in developmental psychopathology at the University of Reading and codirector, with Peter Cooper, of the Winnicott Research Unit. She is also professor extraordinaire at Stellenbosch University in South Africa. Her work principally concerns the development of children growing up in the context of adversity: this includes children of postnatally depressed, and anxious, mothers, children of parents facing extreme socioeconomic adversity, and children with congenital difficulties such as difficult temperament and cleft lip. Her research with these populations has included longitudinal prospective studies, experimental investigations, and treatment trials. She is coeditor, with Peter Cooper, of Postpartum Depression and Child Development (1997) and the author of The Social Baby (2000) and The Psychology of Babies: How Relationships Support Development from Birth to Two (2014).

Michael W. O’Hara is a professor of psychology at the University of Iowa. He has published extensively in the area of perinatal depression for over 30 years. His principal interests are in interventions for perinatal depression, particularly in the use of interpersonal psychotherapy. He recently coedited an issue of Best Practice & Research Clinical Obstetrics & Gynaecology entitled “Perinatal mental health: Guidance for the obstetrician-gynaecologist.”

Heather O’Mahen, PhD, is a senior lecturer/assistant professor in clinical psychology in the Mood Disorders Centre at the University of Exeter, United Kingdom. Dr. O’Mahen conducts research on identifying and modifying factors to increase access to psychological treatments for perinatal mental illness. She has specific interests in using technology to augment delivery of perinatal treatments. She has recently published several clinical trials investigating treatments for perinatal depression, including an online behavioral activation treatment for postnatal depression.

Stavros Petrou is a professor of health economics within Warwick Medical School, University of Warwick, United Kingdom. He leads a research group conducting high-quality economic evaluations and research alongside large phase III clinical trials and within health technology appraisal reviews. In recent years, he has pursued a methodological and applied research agenda largely focused on economic aspects of perinatal and pediatric health care. Prior to his appointment by the University of Warwick in 2010, Stavros was employed for 13 years as a health economist by the University of Oxford. During that period, he held an MRC Senior Non-Clinical Research Fellowship and conducted several research projects on economic aspects of perinatal depression. He remains a research associate at the Nuffield Department of Population Health, University of Oxford.

Nicole Reilly is a senior research associate at the Perinatal and Women’s Mental Health Unit, St John of God Health Care, and lecturer (conjoint) at the University of New South Wales. She has worked in the field of perinatal mental health for 10 years and has a particular interest in the role of policy initiatives in improving outcomes for women and families and in the use of population-based data to examine these issues.

Dr. Tom Ricketts is a nurse consultant in psychotherapy within the NHS in England. He has extensive experience in delivering cognitive behavioral psychotherapies and the training and supervision of others delivering those therapies. Tom designed and evaluated the health visitor training in the PoNDER trial. His research interests include psychological therapies for longer-term depression, the effectiveness of routine NHS psychotherapies, and the impact of training and clinical supervision on outcomes. He is an honorary research fellow within the University of Sheffield School of Health and Related Research.

Dr. Rosanna Rooney is the director of clinical psychology at Curtin University and codirector of Aussie Optimism funded by the Mental Health Commission (Western Australia). She specializes in depression and cross-cultural mental health and, along with her colleagues, has held over three million dollars worth of grants in the areas of postnatal depression across cultures and preventing and reducing anxiety and depression in children. She has been instrumental in writing guidelines for reducing the stigma of mental illness in communities with culturally and linguistically diverse (CALD) backgrounds.

Dr. John Seeley is a senior research scientist at the Oregon Research Institute (ORI) with a special interest in mood and disruptive behavior disorders, behavioral health intervention, research design and program evaluation, and health-related technology. He has over 25 years of experience conducting epidemiologic and intervention research on depressive disorders and as the lead methodologist on many large efficacy and effectiveness trials. His current emphasis is on general methodological issues in research involving web-based behavioral interventions, as well as evaluations of programs that target specific issues such as depression, parenting, physical activity, grief, and tobacco cessation.

David Stanley is the founding director of Convenience Advertising, an international public health agency that over the past twenty-nine years has developed the field of narrowcasting. In the past thirteen years, through preventionXpress, David has focused on the development of preventative health screening using digital and touch screen technology and working in collaboration with health professionals and researchers.

Dr. Anne Sved Williams is a director, Perinatal and Infant Mental Health Services, Women’s and Children’s Health Network, South Australia, and clinical senior lecturer, University of Adelaide. Anne’s work in psychiatry has included the development and delivery of teaching packages in perinatal and infant mental health in many parts of Australia. Publications include coediting Infants of Parents with Mental Illness: Developmental, Clinical, Cultural and Personal Perspectives (2008). Current research focuses on borderline personality disorder in perinatal populations.

Katherine L. Wisner, MD, MS, is the Norman and Helen Asher professor of psychiatry and behavioral sciences and obstetrics and gynecology and director of the Asher Center for the Study and Treatment of Depressive Disorders at the Northwestern University Feinberg School of Medicine. She is internationally recognized as an expert in mood disorders across childbearing. She has published a screening study of 10,000 women with follow-up home visits and assessment across the first postpartum year.

Barbara P. Yawn, MD, MSc, is a family physician researcher, director of research at the Olmsted Medical Center, and adjunct professor in the Department of Family and Community Health at the University of Minnesota. She focuses her work on areas of screening, screening outcomes, and implementation research. She has worked on issues in the perinatal period for more than 20 years and recently completed a 5-year clinical trial of postnatal depression screening and management in primary care. Dr. Yawn has served as a member of the US Preventive Services Task Force and five National Institutes of Health guideline panels, published over 300 papers in peer-reviewed journals, edited three books, and authored numerous book chapters.

Foreword

To screen or not to screen, that is the question! This timely book provides the reader with a scholarly examination of how to answer this important public health question—and above all how to implement the answer. Of course, as the contributors have made plain, the answer will vary across the world according to the resources available and the relative prominence of scientific and folk beliefs about explanatory models of perinatal mental health.

I recently concluded a plenary lecture at the Health Visitor’s Institute in London by saying, “Of course you should screen for perinatal mental disorder—you are skilled health professionals.” There should, I believe, be no debate about whether, even in the fast-paced, underresourced milieu of a community health service, we should devise ways of identifying those mothers with severe perinatal mental disorders. The EPDS was first developed because it was self-evident in Scotland that women with moderate or severe depression were being missed by primary care services and that screening tools were therefore necessary to reduce the chances of a calamitous outcome for the whole family.

The reader must, however, decide whether universal screening for perinatal mental disorder, or even nationally implemented targeted screening that can be sustained over time, is desirable, ethical, and practical. The authoritative contributors do not beat about the bush in this regard—nor have the editors avoided consideration of the need for the specific diagnostic and management skills of psychiatrists and other professionals or the need for a cogent differential diagnosis as a component of any screening pathway.

The decision to implement screening may in part depend on whether a national committee or ministry of health regards screening for mental disorder as having parity of importance with screening for diabetes, bowel cancer, or hypertension. I believe it should—and the scientific scrutiny of the evidence should be no less, and no more, than that applied to screening for prostate or breast cancer, for example. Applying rigorously the UK’s National Screening Committees criteria for targeted screening program (e.g., sensitivity of the test, nature of the disorder, availability of cost effective treatments, and risk of harm) would have halted many of the screening programs for these conditions currently being implemented in the United Kingdom. The use of screening tools such as the EPDS or the PHQ and the interpretation of their scores require the participation of a trained health worker in the same way as the prostate-specific antigen test, fecal occult blood, and a random blood pressure check.

Paradoxically, this fully referenced book highlights the continued limitations of DSM-5, which has failed to categorize adequately the puerperal psychoses and the perinatal nonpsychotic mood disorders; the disorders that are the target of the screening programs discussed by the contributors of this volume. Let us hope that ICD-11 may yet fulfill more satisfactorily this crucial public health task.

This is a landmark book that should be read around the world. The scholarly editors of this volume have shown that multidisciplinary approaches to perinatal mental health are essential and that the Marcé Society (which cradled the EPDS) will therefore continue to motivate researchers and clinicians and inspire the burgeoning advocacy groups which are demanding improved services for childbearing mothers and their families.

John Cox

Professor Emeritus, Keele University, Staffordshire, UK

IntroductionCurrent Issues in Identifying Perinatal DepressionAn Overview

Jeannette Milgrom and Alan W. Gemmill

The idea behind this new book on the identification and management of perinatal depression is to provide researchers and practitioners with an up-to-the-minute reference text on how and whether to undertake active identification in the context of the latest research and expert opinion. We believe that the value in such a publication lies in allowing a regrouping and updating of various disparate sources of guidance and information on perinatal depression identification.