THE EDINBURGH POSTPARTUM DEPRESSION SCALE (EPDS)

Postpartum Depression (PPD), same as Postnatal Depression (PND – which by the way, I have found is used a lot in the UK) is one of the most common mental health disorders in women. Statistics show that between 11 and 20% of women who deliver every year will experience symptoms of PPD. That’s about 2 in every 10 women are going to get PPD. One of the tools that has been developed to identify women who are at risk of perinatal (that is both antenatal and postpartum) depression is the Edinburgh Postnatal Depression Scale (EPDS). EPDS is an efficient screening tool that consists of 10 questions listed alongside a set of values. Below are the guidelines for using the EPDS.

  1. The mom-to-be/ mom is asked to tick the answer that describes closely how she has been feeling in the previous 7 days.
  2. All questions must be answered.
  3. Caution should be exercised to ensure that answers are not discussed as this could skew the results. That is, answers should only come from the expectant woman or mother herself.

NOTE: The EPDS is not a diagnostic tool and must be used alongside clinical assessment. For this reason, it should not be used for self-diagnosis. If you go through this set of questions and suspect that you may be suffering, consult a doctor to ensure you get professional help. Secondly, one of the questions (#10) is on suicidal thoughts and must be answered before the report is submitted. If the item is checked, a follow up should be made so as to ascertain the level of risk and make the necessary arrangements for mother and child.

Read More: Depression during pregnancy

As you are pregnant or have recently had a baby, we would like to know how you are feeling. Please check the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today. 

Here is an example, already completed. 

I have felt happy:

 [ ] Yes, all the time 

 [X ] Yes, most of the time 

[ ] No, not very often

[ ] No, not at all

This would mean: “I have felt happy most of the time” during the past week. 

Please complete the other questions in the same way.

 

In the past 7 days:

  1. I have been able to laugh and see the funny side of things

[ ] As much as I always could

[ ] Not quite so much now

[ ] Definitely not so much now

[ ] Not at all

 

  1. I have looked forward with enjoyment to things

[ ] As much as I ever did

[ ] Rather less than I used to

[ ] Definitely less than I used to

[ ] Hardly at all

 

*3   .I have blamed myself unnecessarily when things went wrong

[ ] Yes, most of the time

[ ] Yes, some of the time

[ ] Not very often

[ ] No, never

 

  1. I have been anxious or worried for no good reason

[ ] No, not at all

[ ] Hardly ever Yes

[ ] sometimes Yes

[ ] very often

 

*5.  I have felt scared or panicky for no very good reason

[ ] Yes, quite a lot

[ ] Yes, sometimes

[ ] No, not much

[ ] No, not at all

 

*6.  Things have been getting on top of me

[ ] Yes, most of the time I haven’t been able to cope at all

[ ] Yes, sometimes I haven’t been coping as well as usual

[ ] No, most of the time I have coped quite well

[ ] No, have been coping as well as ever

 

*7.  I have been so unhappy that I have had difficulty sleeping

[ ] Yes, most of the time

[ ] Yes, sometimes

[ ] Not very often

[ ] No, not at all

 

 

*8.  I have felt sad or miserable

[ ] Yes, most of the time

[ ] Yes, quite often

[ ] Not very often

[ ] No, not at all

 

*9   I have been so unhappy that I have been crying

[ ] Yes, most of the time

[ ] Yes, quite often

[ ] Only occasionally

[ ] No, never

 

 

*10.The thought of harming myself has occurred to me

[ ] Yes, quite often

[ ] Sometimes

[ ] Hardly ever

[ ] Never

 

SCORING

QUESTIONS 1, 2, & 4 (without an *)

Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3

QUESTIONS 3, 5¬10 (marked with an *)

Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0

Scores

0-9: Scores in this range may indicate the presence of some symptoms of distress that may be short-lived and are less likely to interfere with day to day ability to function at home or at work. However if these symptoms have persisted more than a week or two further enquiry is warranted.

10-12 : Scores within this range indicate presence of symptoms of distress that may be discomforting. Repeat the EPDS in 2 weeks time and continue monitoring progress regularly

. If the scores increase to above 12 assess further and consider referral as needed.

13 +: Scores above 12 require further assessment and appropriate management as the likelihood of depression is high. Referral to a psychiatrist/psychologist may be necessary.

Item 10: Any woman who scores 1, 2 or 3 on item 10 requires further evaluation before leaving the office to ensure her own safety and that of her baby.

 

Resource Material

Source: Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786.

Screening for antenatal depression with the Edinburgh Depression Scale

 

 

 

This is what I wish I knew while I was pregnant.

I have done a list on 10 things I would tell my pregnant self, which you can read here, but seemingly, so many of my friends are expecting their bundles of joy. So, I thought, another 10 or so (we will see) will not hurt. This post was birthed by the conversation I had with my pal whose daughter is just 2 months old. She was sharing on some of the shocking things that she experienced while she was expecting, and the least of which is talked about. In retrospect, I realized this was my case too! There were so many things I wished I knew, most of which were never shared. Here goes.

  1. You will be an emotional wreck, a whole lot more than you think.

Whether due to the upsurge of pregnancy hormones, or just the sheer thought of bringing new life to these world, your emotions will be all over the place (Got to love how well Shiko of The Green Calabash puts it in this post). I remember once, crying in a Thika-bound matatu, not the pretty crying. Ugly-sobs-mucus-type of crying. It does get overwhelming sometimes, so grab a box of tissue honey, and rock on.

  1. Things get, ermm… slippery in South Pole.

Pantyliners are your friend. Enough said.

Read More: Baby Shower!

  1. Labor is different for everyone.

This, I think, was one of those topics I steered away from when I was expecting my son. Enough with the horror stories, the grotesque images and everything in between, Granted, child birth is not a high tea party, but then again, moms-to-be need not be pumped with all the crazy happenings. It will help to give insight into what to expect, but in my view, all the horror stories are to be saved for later (probably after delivery). That’s just my 2 cents.

So yes, some will have the ‘she-just-came (and I still had my makeup on)’ narrative, and others, by the time their newborn is put in their hands, will have said unprintables, danced kanungo, gotten rid of every burden in the form of clothing and realized that there’s a level of pain where words and tears do not suffice. All that matters, is to take the journey in stride, however it comes.

  1. It is a whole new season of adjustments with breastfeeding.

Cracked. That Nivea ad doesn’t even do justice to try and imagine what cracked feels like. Now, picture cracked nipples, and a little clueless human being trying to latch. This is HARD. And on many days, you will want to give up, because sore bloody nipples are not anyone’s cup of tea. Good old Vaseline will be your friend, amidst all the shrieks and tears (I dreaded breastfeeding for this very reason on those first days, but it does get better. So, no, there’s nothing wrong with you!)

Read More: The Place of vulnerability

  1. Lochia is a thing.

The glee on my face when I realized I would be off periods for 9 months, could actually be packaged and sold for a pretty penny. But you see, the human body has a way of reminding you who the boss is. And so, immediately after delivery, the nurse tells you that you should expect lochia for the next couple of weeks.

Lochia is the medical term that refers to the vaginal discharge after birth. This discharge contains blood, tissue from the uterine lining and bacteria. Or in other words, it is payback for the 9 months you did not bleed, hah! Some women will experience cramps too, so painkillers will come in handy. And do not forget the maternal maxi pads, you know, the ones that feel like you rolled a gunny bag and placed it in your Mother Unions (which, by now, are like the best things after porridge and sleep) – those ones.

  1. You may have to re-invent your wardrobe

Those strappy tops you had that held your bosom in place and did not move an inch, forget them. Because, guess what, you need clothes that allow you to whip that boob out comfortably, and on LO’s demands. Invest in button-down blouses, zipped tops and anything else that allows easy access to the lactose zone.

Read More: 7 gross things moms do

  1. You may not be able to bond with your child immediately

This, I have to slip in here a second time. Not all moms will have an instant bond with their child, whether due to the trauma of labor, or depression during pregnancy, or sometimes simply the overwhelming experience that this new chapter represents. And that is okay, to a certain extent.

Baby blues are fairly common, and will often die down on their own. In Postpartum Depression however, these blues only intensify. They have a vice-like grip on any mom, and will often wash up like mighty waves on the shore of your heart. If you do experience this, do not be afraid to get medical attention. There is no shame in asking for help. So chin up! (If you would like to read more on Postpartum depression, click here).

  1. They grow

In spite of the challenges at the onset, the kids grow. A proverb in my local language loosely translates to “Kids do not have stones on their heads” – easy to see why. Then we shall miss the infant stages where they are cute, cuddly and composed, before they get to 5 and you feel like you are handling a blender whose settings have been turned on… without the damn lid! And we shall be back to bringing other life to this world.

Is there anything I have missed on the two entries? Drop by in the comments below.

Grace moments in the mundane

One of the things I struggled with when I had Postpartum depression (PPD) was channeling my frustrations at my baby (sometimes subconsciously, other times consciously, thanks to the monster that depression is). It has been, and still is, a work in progress. I am glad for the progress thus far; it is not something I take for granted. The other day, I had an incident that made me smile, think of it as my pick me up.

After a particularly hard day (with work, power blackouts and just the toll working from home has on any mom), I was not having my best of moments. It didn’t help LO was in a super exuberant mood. Exuberant here means active, energetic, and just about everything that resembles blending food without your lid on! And so somewhere in that mishmash of events, I found myself lashing out, initially just venting out loud before it morphed into talking AT him…

Read More: A letter to my son – Chronicles of a PPD survivor

At some point I literally just had to walk away because I felt my frustrations boiling in me past tipping point. LO came around, and for a moment, I pursed my lips thinking, “Oh boy, not now.” Then he did what I least expected. He stretched forth his hands and gave me the warmest bear hug I have had in the last couple of weeks.

In that very moment, every frustration melted away. For a couple of seconds, I was holding on to the fleeting nature of his kind gesture, soaking in the warmth and embracing the gift of grace at the least expected times. These ‘Small’, and I hesitate to use the word small, moments of grace in the midst of mundane days. I carried this with me for the rest of the week, and to-date. I don’t think there’s a better pick me up than the genuine innocence of a child’s kindness. A constant reminder of the far we have come from scary anger.

Featured image

Day 3 – Postpartum Depression Therapy

This is the third day of my 30 day writing challenge, and today I wanted to highlight therapy options available for those suffering from Postpartum Depression (PPD). Please not that this post, and any other on the blog does not reflect a professional angle to this mental health condition, and is simply a platform for me to help other moms who may be going through what I did, as well as create awareness for the same. Do have a look at the Medical Disclaimer page on this blog if you have any concerns.

This post would be a follow up of sorts to one I wrote on the Symptoms of Postpartum Depression which you can check out here. Looking out for these symptoms is an effective way to gain clarity into this condition for the simple reason that there is not a single specific test that diagnoses the presence of PPD. Consequently, for therapy to begin, health practitioners are tasked with collecting extensive information as pertains to an individual’s medical past, their health history as well as the circumstances surrounding their pregnancy; generally a background check into their life.

Once this is complete, a health professional can then outline the ideal form of treatment. Typically, therapy for moms and dads usually starts off from non-medication before proceeding to medication (Yes, dads suffer PPD too!! You may want to read this entry on Huffington Post, written by Mark Williams to get some insight. This amazing account on Rosey’s blog is also an eye opener). Below are brief descriptions of some of the treatment options available.

Psychotherapy – This form of therapy revolves around hand in hand with health professionals to analyze and attempt to solve factors that contribute to PPD. For the most part, this is an incredible form of intervention. Severe PPD may require more intense psychotherapy sessions, and this will usually take months, up to a year to show results. It has the advantage of eliminating medication so that moms who are breastfeeding are able to do so without any pharmcological intervention. Therapists develop programs to help patients get through PPD so that they do not relapse. This form of therapy also involves support-based therapy that may include home visits and Internet-based cognitive behavioral therapy

Medication – Medication therapy consists of antidepressants prescriptions. Various medicines are available in the market, a good number of which the preferred mode of action is the tweaking of the concentration of brain chemicals which are known to affect levels of depression.The period of time it takes for PPD healing through medication varies from one person to another.

In many instances, a combination of the two is offered. It is recommended that moms and dads affected by PPD see a health professional to ascertain the preferred mode of therapy.

PS: If you would like a more academic angle to the prevalence of PPD in Kenya, and more specifically at Kenyatta National Hospital (the country’s biggest referral hospital), this paper by Dr. Mwikali Musau may interest you.

Featured Image photo credits: Postpartum Progress