Diagnosis and clinical screening

Early diagnosis of perinatal depression is one of the most effective strategies for preventing serious complications for the mother, baby, and their environment. Although it is one of the most common complications of pregnancy and the postpartum period, it remains widely overlooked.

This is due, in part, to a lack of clinical knowledge about the appropriate diagnostic criteria, as well as the weight of cultural stigmas that make it difficult for women to openly express their emotional distress during pregnancy and the postpartum period.

Importance of early diagnosis

Early detection allows for intervention before symptoms become chronic or escalate to serious conditions such as postpartum psychosis or maternal suicide. However, many women are not diagnosed in time because they appear to be functioning normally.

They may be well dressed, attend check-ups, and care for their baby, while internally experiencing distress, irritability, or feelings of guilt. It is therefore essential that healthcare professionals actively ask about the emotional state of mothers, avoiding the assumption that “if she looks fine, she is fine.”

Diagnostic tools and scales

Validated instruments are available to facilitate systematic screening. One of the most widely used is the Edinburgh Postnatal Depression Scale (EPDS).

This 10-item tool can be completed in less than five minutes and is specifically designed for the perinatal context, as it excludes symptoms such as sleep disturbances or irritability, which could be confused with normal experiences of pregnancy and the postpartum period.

A score of 13 or higher suggests the need for clinical mental health assessment, and any score greater than zero on the question about suicidal ideation (item 10) requires immediate referral.

Another useful tool is the Whooley Questions, a brief two-question screening that asks about the two core symptoms of depression: depressed mood and anhedonia. If the answer to either question is yes, a more extensive scale such as the EPDS is recommended.

Clinical considerations in pregnancy and postpartum

Diagnosis at this stage requires careful clinical analysis, as many depressive symptoms can