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The most common mental health problem is depression, a serious, under-detected condition in which severe feelings of sadness, hopelessness and loss of interest in life interfere with daily life and can last for weeks or months. Affects up to 1 in 3 at least once, and occurs in all age groups, including children and adolescents. Long-term medical conditions increase risk of major depression. A family history of depression also increases risk.
Clinical features of depression
Screening for depression
NICE guidance advises screening high-risk groups, e.g. if past history of depression, significant physical illnesses causing disability, long-term conditions, using two questions concerning mood and interest: 1. During the past month have you often been bothered by feeling down, depressed or hopeless? and 2. During the past month have you often been bothered by having little interest or pleasure in doing things? A 'no' response to both questions makes depression highly unlikely. A 'yes' answer to either question is considered a positive test, and the person should be reviewed by a practitioner competent in mental health assessment. Mixed anxiety/depression is common.
Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier Postnatal depression is a nonpsychotic depressive illness of mild to moderate severity arising within 3 months of childbirth. Main characteristics are:
The Edinburgh Postnatal Depression Scale is a useful screening tool but can lead to 'false positives' and medicalization of low mood and situational distress, and should not replace clinical judgement.
The Practising Midwife features articles
How midwives can help with perinatal depression 2014; 17(3): 22 - 24 Author: Joanne Morton
Cochrane Corner: Dietary supplement for preventing postnatal depression 2014; 17(3): 40 - 42 Author: Valerie Smith
NICE CG90 Depression The treatment and management of depression in adults (update), 2009 http://guidance.nice.org.uk/CG90
NICE CG91 Depression Treatment and management in adults with a chronic physical health problem, 2009 http://www.nice.org.uk/CG91
SIGN 114 (2010) Non-pharmaceutical management of depression http://sign.ac.uk/guidelines/fulltext/114/index.html
Depression Alliance www.depressionalliance.org/
Samaritans http://www.samaritans.org 08457 90 90 90