Pathways to care: A guide to the management of perinatal depression and anxiety

Putting it all together

Once a woman has been screened for depression and anxiety, and assessed for psychosocial risk factors and risk to herself and her baby, it’s time to integrate the screening results with your clinical information, determine what further assessment is required and put together a management plan.

It is helpful to summarise:

1. Presenting concerns (e.g., EPDS of 15, reports low mood and appears anxious)
2. Relevant history (e.g., previous mental health difficulties)
3. Current stressors and triggers (e.g., unsettled baby, difficulty adjusting to first time motherhood)
4. Maintaining factors – what’s keeping them stuck (e.g., limited support, conflict in spousal relationship)
5. Protective factors – strengths (e.g., appears to have good bond with baby, reports close relationship with mother)
6. Major difficulties to be addressed (e.g., further assessment of depression)

The diagram below shows how PIRI’s 4-step electronic clinical decision support system, PIRIMID (Perinatal Identification, Referral and Integrated Management for Improving Depression), guides health professionals through the development of a management plan.