The Problem with Postpartum Depression Screeners

If you have had a child already, you are likely to have filled out the Edinburgh Postnatal Depression Scale (EPDS). The EDPS is a 10 item questionnaire where you are asked about the frequency of common depression symptoms over the past two weeks. As medical providers have become increasingly aware of postpartum depression, some women might take these surveys during their 6 week check-up at the OB. Of course, 6 weeks of suffering with depression or anxiety is waaaaaay too long (said in my most professional manner).

Pediatricians have tried to fill in the gap of time (while also looking out for the baby's well-being) by administering the screener. Well, I really shouldn’t say “administering” because that would indicate some kind of explanation in advance, developing rapport before, during and after, and going through the results question by question to understand if a patient is really feeling depressed.

I remember filing out the screener at my daughter’s one month check-up after weeks and weeks of “failed” attempts at breast-feeding. I made the decision to answer the questions honestly, I thought it was some kind of important part of being a mental health provider. The entire meeting with the pediatrician was about the importance of breast-feeding my daughter. We reported all we had done to try to make nursing “work”, and all the ways it wasn’t working. At the end of the meeting, she pulled out the results of the screener and flatly, without eye contact, told me I might be depressed and implied I should do something about it.

I was so freaking angry! I couldn’t believe she didn’t put the two pieces together. Yep, “not really looking forward with enjoyment to things” because I’m always focused on nursing. Yep, I “blamed myself unnecessarily” for not being able to breastfeed because it was strange to try to blame my newborn. Yep, “things have been getting on top of me” because how am I going to do anything else around the house when I’m triple feeding and my partner goes back to work?

I have to say, despite my personal negative experience I still like the screener as a therapist. From a nerdy psychometric perspective, it has good validity and reliability. It really helps me understand how my clients are feeling, the specific symptoms that are most bothersome, and track changes over time. However, it does matter who “administers” the screener. It also matters that sometimes we might not feel safe to answer honestly.

It is important that we remember that the questionnaire is a screening tool, not a diagnostic tool. Moreover, despite depression and anxiety thoughts telling us otherwise, there is no shame in PPD & PPA. So if you are not feeling yourself, constantly worrying or anxious, and struggling to sleep even when it’s time to sleep, I encourage you to reach out to talk to someone supportive.