Post-partum depressions: Delimitation of a high risk group immediately after birth. A prospective evaluation and mother-baby relations

The authors present the methodology and the results of a prospective unicentric epidemiological survey on post-partum depressions (PPD). The Cox scale of post-partum depression (Edinburgh Post-Natal Depression Scale) is used immediately after post-partum at the maternity, clinic, then six weeks after childbirth during a home visit. The aim of this study, is to observe the relationship between the two scores with the perspective of precocious screening of this frequent pathology (10 % of women are concerned) which has an important impact on the mother-baby, relationship, although the intensity, of the depression properly, speaking. usually remains moderate. Various medical and social parameters are also analysed as well as a clinical appreciation of the quality or the difficulties in the mother-baby relationship. This survey concerned all women hailing given birth in the maternity clinic of the Marseille university hospital and living in a predetermined geographical zone. It took place over 67 days separated into five segments. 196 women were included. 98 women, that is 50 %, accepted the entire survey carried out at two intervals 1) questionnaires and an interview while still at the maternity clinic 2) questionnaires and an interview during a home visit six weeks after childbirth. Of the 98 women visited at their homes, the EPDS made it possible to discover a depressive syndrome for 10 % of them six weeks after childbirth. What is more, the EPDS is a reliable, instrument for screening the group at risk at the maternity, clinic when we use a threshold value equal to eight for the EPDS score. Indeed, very few women having a score lower than this number present a score in favor of a PPD six weeks after childbirth. The negative predictive value is thus 9 7 %. The concentration power of such a test corresponds to the efficient selection of a group at risk for a later PPD since the positive predictive value is 30 %. The depression is correlated with the observation of troubles in the relation between the mother and the baby, and this justifies the offer of eary active help. However, some results, for example low scores of the Hamilton Depression Scale for clinically, depressed women who have a high score on the EPDS are in favor of the heterogeneity of post-partum depressions and go in the direction of a greater complexity of this concept than might be imagined at first. Furthermore, the refusal to participate in such a survey, which ire will analyse later, illustrates the limits of precocious PPD screening. This question is a familiar one for people specializing in perinatal mental health, and the feelings of guilt and the fantasies of being a bad mother (shared by, some caregivers) seem to hamper requests for help.