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Screening for Psychiatric Morbidity in the Postpartum Period: Clinical Presentation and Outcome at One-Year Follow-Up

Tang A, Liang HJ, Ungvari GS and Tang WK

Background: There are few data on the psychiatric morbidity of postnatal women in Hong Kong, and even fewer data on their clinical outcome. This study targets these issues.
Methods: A prospective design was used. Women were screened by Edinburgh Postnatal Depression Scale (EPDS, with 9/10 as cut-off), and 12-item General Health Questionnaire (GHQ-12, with 4/5 as cut-off) within 4-6 weeks following delivery over a 20-month period. Those suspected for a psychiatric disorder were contacted by telephone and were offered a referral to a postnatal depression disorder (PND) clinic. Women were re-evaluated with EPDS, GHQ-12, and Beck Depression Inventory (BDI, with 10/11 cut-off) at the clinic. Psychiatric diagnoses, treatments and outcome were evaluated at 6-month and 12-month after the women’s first attendance.
Results: Altogether 7,833 questionnaires were sent out and 6,212 were mailed back. Scores were above the cutoff for 2,107 women. Only 120 women reported persistent symptoms but only 96 attended the PND clinic. The most common diagnose was mood disorders (56.3%). No postpartum psychosis was found. Only 11.1% of women with MDD recovered one year after delivery.
Conclusion: Depression is the main psychiatric morbidity in Hong Kong postnatal women. Compliance of referral and treatment and treatment outcome of PND are poor, suggesting extrending psychoeducation for patients and relatives and developing a comprehensive treatment model would be essential in improving postnatal psychiatric care.