Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

If you know someone who's expecting a baby this summer, you have plenty of company. More babies are born in July, August, and September than in any other months of the year, according to 2010 Federal data [PDF File].

A new baby brings joy and excitement. But for some women, it can also bring on the start of serious depression. Known as postpartum depression, this condition often starts shortly after a woman gives birth, but it can also begin up to a year later.

Signs of postpartum depression are similar to the symptoms of major depression. They include—

  • Feeling sad or depressed most of the time.
  • Having no interest in doing things a person used to enjoy.
  • Losing or gaining a lot of weight in a short time.
  • Being unable to sleep or sleeping too much.
  • Feeling guilty or worthless.
  • Thinking about death or suicide.

Major depression in women who have given birth in the previous year affects between 1 and 6 percent of the population. In the first 3 months after giving birth, the incidence is higher than 6 percent.

New mothers with postpartum depression have unique needs because they are caring for infants. When this condition isn't treated, it can result in a higher risk of infant death, poor infant development, and a greater use of unneeded health services for mother and infant, a 2009 report found.

One problem is that the signs of postpartum depression can look the same as the natural stresses of caring for a newborn. Who doesn't know a new mother who has been up all night—or several—with a crying infant? Women who are exhausted or sad might be mistakenly be diagnosed with this condition.

The good news is that women who get tested and treated for postpartum depression can recover faster from the symptoms than women who don't, according to a new review from AHRQ's Effective Health Care Program [PDF File]

The review, conducted for AHRQ by Duke University with input from experts in child and maternal health, looked at 40 studies. About half of the studies used well-known depression screening tests to assess a woman's risk.

Women who tested positive for depression did better when the screening, diagnosis, and treatment were all provided in the same place. Unfortunately, when these elements of care aren't available in the same place, fewer than half of patients are referred for followup treatment.  Screening for postpartum depression can be helpful, especially when it's convenient for patients.

Currently, we don't have a "standard of care"—like the schedule of vaccines for children, for example—for the best type of depression screening test, who should receive it, and when it should be given. And we don't have enough evidence about what which approach works best once a positive diagnosis is made.

Clearly, more research is needed. Postpartum depression is a serious condition whose signs can appear at a time when everyone—new mothers included—expects just the opposite. Understanding that it can be tested, diagnosed, and treated is a big step in the right direction.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality. Effective Health Care Program
Efficacy and Safety of Screening for Postpartum Depression. April 2013
http://www.effectivehealthcare.ahrq.gov/ehc/products/379/1437/postpartum-screening-report-130409.pdf

Centers for Disease Control & Prevention
National Vital Statistics Reports, Vol. 61, No. 1, August 28, 2012
http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01_tables.pdf#I02

U.S. National Library of Medicine, National Institutes of Health
Postpartum Depression: MedlinePlus
http://www.nlm.nih.gov/medlineplus/postpartumdepression.html

National Research Council, Institute of Medicine
Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. 2009
http://www.nap.edu/catalog.php?record_id=12565  

Current as of June 2013
Internet Citation: Not Just the Baby Blues: Screening Can Help Address Postpartum Depression. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/061113.html