title: Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.
abstract: OBJECTIVE
  The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression.
  
  
  OBJECTIVE
  To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions.
  
  
  METHODS
  Sequential case series of women who recently gave birth.
  
  
  METHODS
  Urban academic women's hospital.
  
  
  METHODS
  During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes.
  
  
  METHODS
  A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses.
  
  
  RESULTS
  Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders.
  
  
  CONCLUSIONS
  The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00282776.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. katherine.wisner@northwestern.edu
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wisner
authors.forename: Dorothy K Y
authors.initials: DK
authors.lastname: Sit
authors.forename: Mary C
authors.initials: MC
authors.lastname: McShea
authors.forename: David M
authors.initials: DM
authors.lastname: Rizzo
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Zoretich
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Hughes
authors.forename: Heather F
authors.initials: HF
authors.lastname: Eng
authors.forename: James F
authors.initials: JF
authors.lastname: Luther
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Costantino
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Confer
authors.forename: Eydie L
authors.initials: EL
authors.lastname: Moses-Kolko
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Famy
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Hanusa
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D015995:Prevalence; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult