Following up on Risk Factors for Postnatal Depression
Psychosocial Risk Factors:
As part of the screening tool the woman has completed, the following Psychosocial Risk Factors were assessed and have been itemised in the summary box in Step 1 of PIRIMID if present
• Personal history of mental health problems
• Current life stress
• Poor maternal relationship (with own mother)
• Lack of available practical or emotional support
If present, you can add further well established psychosocial risk factors for postnatal depression
• Antenatal depression and/or anxiety.
• Lack of support from partner or marital problems.
• A family history of depression and/or other mental health difficulties.
• Major life events and stresses (for example, death of a relative, relationship break up, unemployment, moving house, miscarriage, illness and pregnancy and birth for some etc.)
• History of abuse/domestic violence
• Current drug or alcohol use
Consider other stressors that might be present and common during this time
• Experiencing severe ‘baby blues’ (the very common drop in mood that most women feel not long after having a baby).
• Complications in labour and/or delivery.
• Problems with the baby’s health.
• Difficulty breastfeeding.
• Difficulties in close/family relationships.
• Single parenthood.
• An unsettled baby (difficulty with feeding or sleeping.)
• Unrealistic expectations about motherhood.
• Personality factors e.g. being shy, self-conscious, a “worrier” or a “perfectionist”.
• Previous miscarriage/stillbirths.
• Dysfunctional family relationships.
• Low income and unemployment.
• Poor housing
• Poor physical health in self or family members
• Baby health concerns
Direct Questions to identify the Presence of Psychosocial Risk Factors for Depression
Assessing past and/or present mental health disorders
• “Have you ever needed treatment for a mental health condition such as depression or anxiety disorders, bipolar disorder or psychosis?”
• When did you need treatment and what type of treatment did you receive? (i.e., medication, individual counselling etc.)
• “Has anyone in your immediate family (i.e., grandparents, parents, siblings) experienced severe mental health problems?”
• Did the mental health issues include any significant depression, bipolar disorder, psychoses, self-harm and/or suicide attempts; or significant drug and alcohol use?
Current Practical and Emotional Support
• “If you found yourself struggling, what practical support do you feel would be available to you? Who could help provide that?”
Modify the above question according to the woman’s cultural and educational background as women may interpret terms such as ‘struggling’ and/or ‘support’ differently.
Recent Life Stressors
• “Have you had any major stressors, changes or losses in the last 12 months – for example, financial strain, relationship problems, loss of someone close to you or have you moved house?”
Can you tell me more about this event? What impact has this had on you and your family? How have you coped?
Quality of a women’s attachment to her own mother
• “When you were growing up, was your mother emotionally supportive of you?” “
Current drug and alcohol use
• “Do you or others think that you (or your partner) may have a problem with drugs or alcohol?”
Past and/or current physical, sexual or psychological abuse
• “When you were growing up, did you always feel cared for and protected?”
“If you currently have a partner, do you feel safe in this relationship?”