Prediction and prevention of perinatal mental illness

This article looks at whether the psychiatric disorders that occur around childbirth can be predicted and, if so, whether they be prevented. Childbirth does present a risk to a woman’s mental health, and the most severe psychiatric condition associated with it, puerperal psychosis, is especially predictable in those with a past history of bipolar disorder, which increases the risk to at least 1 in 3. The less severe types of postnatal depression are not so predictable, although certain factors seem to increase the risk. These can be biological, obstetric, and psychosocial, but it has not yet been possible to use these to develop a sufficiently powerful antenatal questionnaire that would predict women at risk. Prevention is divided into primary, secondary, and tertiary aspects, and possible strategies for women at risk are discussed. Universal primary prevention targets the population as a whole, selected all pregnant women and indicated just those at risk. Secondary prevention involves screening; it does have limitations and these are considered. The Edinburgh Postnatal Depression Scale has been used widely since its development in 1987 following the realization that traditional depression scales were not suitable for depression occurring postnatally. There is some controversy over this, which is also discussed briefly. Tertiary prevention considers how to minimize the effects of a condition that has already occurred with appropriate management and treatment. Finally there is a mention of how integrated care pathways can be used to facilitate screening and planning of care.