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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

  • Symptoms of low mood: little interest (anhedonia), poor concentration, apathy/helplessness/hopelessness, tearfulness, pessimism
  • Somatic symptoms: poor appetite, weight loss, insomnia, constipation, low libido.
  • Psychotic symptoms: hallucinations, delusions.

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.

Postnatal depression

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:

  • Diurnal mood changes and sleep disturbance - waking early in the morning; the woman will feel most depressed and her symptoms will be worse at the start of the day.
  • Impaired concentration, disturbed thought processes, indecisiveness and an inability to cope with everyday life.
  • Emotional detachment and profound lowering of mood
  • Loss of ability to feel pleasure (anhedonia)
  • Feelings of guilt, incompetence and of being a 'bad' mother
  • In approximately one-third of women, distressing, intrusive obsessional thoughts
  • Commonly, extreme anxiety and even panic attacks
  • Impaired appetite and weight loss.
  • In a small number, depressive psychosis, morbid, delusional thoughts and hallucinations.

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

Further reading/resources

NICE CG90 Depression The treatment and management of depression in adults (update), 2009

NICE CG91 Depression Treatment and management in adults with a chronic physical health problem, 2009

SIGN 114 (2010) Non-pharmaceutical management of depression

Depression Alliance

Samaritans 08457 90 90 90


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