Perinatal distress: early screening and management

Perinatal distress is an umbrella term used to describe symptoms of depression, anxiety and stress that women may experience from conception to one year following birth. This also includes pregnancy loss such as miscarriages, stillbirths, terminations, infants born with disabilities, etc.

There are many factors that can cause perinatal distress, including physiological, psychological, social and cultural factors. At particular risk are women who: have had a previous history of depression or anxiety, have relationship issues (particularly domestic violence), have a limited support network (women from CALD communities may be at higher risk), are having financial or major life stresses.

The most common screening tool for perinatal distress is the pdf Edinburgh Postnatal Depression Scale (EPDS) (136 KB) , which is a 10-item questionnaire that can be used frequently. A total score of 13 or more flags possible symptoms of perinatal distress. Particular attention needs to be given to question 10 for risk of suicide or self-harm. The Antenatal or Postnatal risk questionnaires (ANRQ or PNRQ) are also helpful to identify risks and possible causes for perinatal distress. All of these are available on the Black Dog Institute website

Symptoms vary depending on the woman's circumstances and history. They may include low motivation or enjoyment in life, excessive feelings of guilt, low mood, excessive worrying about baby's health (or in general), social isolation. Perinatal distress may also impact on the mother's ability to respond to her baby, which can then impact their relationship and cause attachment issues. Some mums may struggle to express these concerns or may feel unable to voice them due to stigma, guilt or shame. It has been my experience that encouraging women to increase their support network and implementing self-care strategies, as well as providing information and referrals to the early childhood centre and/or culturally appropriate services, can greatly assist in the therapeutic process. Providing written information and contact details is also key, as the woman can keep these resources and use them when required.

Article submitted byAdriana Zapata-Delgado, Clinical Psychologist