Editing Postpartum depression (section)

==Screening==
Screening for postpartum depression is critical as up to 50% of cases go undiagnosed in the US, emphasizing the significance of comprehensive screening measures.<ref name="Ukatu-2018">{{cite journal | vauthors = Ukatu N, Clare CA, Brulja M | title = Postpartum Depression Screening Tools: A Review | journal = Psychosomatics | volume = 59 | issue = 3 | pages = 211–219 | date = 2018-05-01 | pmid = 29396166 | doi = 10.1016/j.psym.2017.11.005 }}</ref> In the US, the [[American College of Obstetricians and Gynecologists]] suggests healthcare providers consider depression screening for perinatal women.<ref name="ahrq2011">{{cite journal| title =Screening for Depression During and After Pregnancy| url =http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Depression-During-and-After-Pregnancy| journal =American College of Obstetricians and Gynecologists, Committee Opinion| date =February 2010| archive-url =https://web.archive.org/web/20141102112919/http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Depression-During-and-After-Pregnancy| archive-date =2014-11-02}}</ref> Additionally, the American Academy of Pediatrics recommends pediatricians screen mothers for PPD at 1-month, 2-month, and 4-month visits.<ref>{{cite journal | vauthors = Earls MF | title = Incorporating recognition and management of perinatal and postpartum depression into pediatric practice | journal = Pediatrics | volume = 126 | issue = 5 | pages = 1032–1039 | date = November 2010 | pmid = 20974776 | doi = 10.1542/peds.2010-2348 | doi-access = free }}</ref> However, many providers do not consistently provide screening and appropriate follow-up.<ref name=ahrq2011 /><ref>{{cite journal | vauthors = Stowe ZN, Hostetter AL, Newport DJ | title = The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care | journal = American Journal of Obstetrics and Gynecology | volume = 192 | issue = 2 | pages = 522–526 | date = February 2005 | pmid = 15695997 | doi = 10.1016/j.ajog.2004.07.054 }}</ref> For example, in Canada, Alberta is the only province with universal PPD screening. This screening is carried out by Public Health nurses with the baby's immunization schedule. In Sweden, Child Health Services offers a free program for new parents that includes screening mothers for PPD at 2 months postpartum. However, there are concerns about adherence to screening guidelines regarding maternal mental health.<ref>{{cite journal | vauthors = Bränn E, Fransson E, Wikman A, Kollia N, Nguyen D, Lilliecreutz C, Skalkidou A | title = Who do we miss when screening for postpartum depression? A population-based study in a Swedish region | journal = Journal of Affective Disorders | volume = 287 | pages = 165–173 | date = May 2021 | pmid = 33799034 | doi = 10.1016/j.jad.2021.03.013 | s2cid = 232773376 | doi-access = free }}</ref>

The [[Edinburgh Postnatal Depression Scale]], a standardized self-reported [[questionnaire]], may be used to identify women who have postpartum depression.<ref name="pmid3651732">{{cite journal | vauthors = Cox JL, Holden JM, Sagovsky R | title = Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale | journal = The British Journal of Psychiatry | volume = 150 | issue = 6 | pages = 782–786 | date = June 1987 | pmid = 3651732 | doi = 10.1192/bjp.150.6.782 | s2cid = 13841634 }}</ref> If the new mother scores 13 or more, she likely has PPD and further assessment should follow.<ref name=pmid3651732/>

Healthcare providers may take a blood sample to test if another disorder is contributing to depression during the screening.<ref>{{Cite web|url=https://medlineplus.gov/lab-tests/postpartum-depression-screening/|title=Postpartum Depression Screening: MedlinePlus Lab Test Information|website=medlineplus.gov|language=en|access-date=2019-11-20}}</ref>

The Edinburgh Postnatal Depression Scale is used within the first week of the newborn being admitted. If mothers receive a score less than 12 they are told to be reassessed because of the depression testing protocol. It is also advised that mothers in the NICU get screened every four to six weeks as their infant remains in the neonatal intensive care unit.<ref name="Davila-2018">{{cite journal | vauthors = Davila RC, Segre LS | title = A Nurse-Based Model of Psychosocial Support for Emotionally Distressed Mothers of Infants in the NICU | journal = Journal of Obstetric, Gynecologic, and Neonatal Nursing | volume = 47 | issue = 1 | pages = 114–121 | date = January 2018 | pmid = 28482172 | doi = 10.1016/j.jogn.2016.12.007 | s2cid = 39562650 }}</ref> Mothers who score between twelve and nineteen on the EPDS are offered two types of support.<ref>{{cite journal | vauthors = Tahirkheli NN, Cherry AS, Tackett AP, McCaffree MA, Gillaspy SR | title = Postpartum depression on the neonatal intensive care unit: current perspectives | language = English | journal = International Journal of Women's Health | volume = 6 | pages = 975–987 | date = 2014-11-24 | pmid = 25473317 | pmc = 4247145 | doi = 10.2147/IJWH.S54666 | doi-access = free }}</ref> The mothers are offered LV treatment provided by a nurse in the NICU and they can be referred to the mental health professional services. If a mother receives a three on item number ten of the EPDS they are immediately referred to the social work team as they may be suicidal.<ref name="Davila-2018" />

It is critical to acknowledge the diversity of patient populations diagnosed with postpartum depression and how this may impact the reliability of the screening tools used.<ref name="Ukatu-2018"/> There are cultural differences in how patients express symptoms of postpartum depression; those in non-western countries exhibit more physical symptoms, whereas those in Western countries have more feelings of sadness. Depending on one's cultural background, symptoms of postpartum depression may manifest differently, and non-Westerners being screened in Western countries may be misdiagnosed because their screening tools do not account for cultural diversity.<ref name="Ukatu-2018" /> Aside from culture, it is also important to consider one's social context, as women with low socioeconomic status may have additional stressors that affect their postpartum depression screening scores.