Early detection and clinical assessment

Early detection of perinatal depression is crucial to preventing adverse outcomes for both the mother and the newborn. Identifying depressive or anxiety symptoms early allows for intervention before the condition progresses and has serious repercussions on the mother-child bond and family dynamics. To this end, it is essential to use validated screening tools, conduct an adequate assessment of the psychosocial environment, and know how to ask key clinical questions.

Use of the Edinburgh Scale and other screening tools

One of the most useful and widely validated tools for detecting perinatal depression is the Edinburgh Postnatal Depression Scale (EPDS).

This self-administered instrument consists of 10 simple questions that assess emotional and anxiety symptoms during pregnancy and the postpartum period. Its use is recommended in prenatal and pediatric checkups during the baby's first year of life.

A score above 10 on the EPDS indicates a significant risk of depression and should alert the healthcare professional to conduct a more in-depth assessment. Question 10, related to thoughts of self-harm, is a criterion for immediate referral to mental health services.

In addition, questions 3 and 5 have been associated with comorbid anxiety. This type of screening allows for the detection of cases that are often not verbalized due to shame, stigma, or fear of being judged as “bad mothers.”

Assessment of family environment, personal history, and social support

A comprehensive clinical assessment should also consider the patient's personal history and psychosocial environment.

It is essential to inquire about a history of affective disorders, suicide attempts, psychoactive substance use, and traumatic experiences such as domestic violence, sexual abuse, or pregnancy loss.

Any obstetric complications, fertility treatments, or traumatic births should also be assessed. The level of social support is another key factor. The lack of a support network (family, partner, friends), isolation, or an overload of responsibilities without external help increase the risk of depression.

Asking who the patient lives with, whether she receives help with childcare, and what her relationship with her partner is like allows us to gauge the level of emotional and practical support she has.

It is especially useful to observe the mother-baby relationship: a mother who is overly anxious, apathetic, or distressed in her bond with her child may be exhibiting symptoms of depression even without verbalizing them directly.

In many cases, the first signs emerge in the pediatric office, when the mother repeatedly consults about minor symptoms in the baby, actually expressing her own unrecognized distress.

Key questions for clinical detection

During the interview, asking open-ended, non-stigmatizing questions allows the woman to feel safe to talk. Some key questi