Postnatal depression in the community.
BACKGROUND: Postnatal depression affects 15% of all women derived. Good practice in antenatal and postnatal care suggests that regular contact should take place with members of the primary health care team (PHCT) but, despite this, many cases of postnatal depression are probably not detected. It is also widely perceived that depressed women consult more frequently about themselves and their babies, but it is not clear whether the number of contacts with the primary health care team as a whole reflects this. AIM: To determine whether the use of the Edinburgh Postnatal Depression Scale (EPNDS) at postnatal examination would detect women not recognized as depressed by the PHCT. To determine whether the number of contacts with the PHCT could be used as a screening tool for postnatal depression. METHOD: The EPNDS was administered at postnatal examination to 176 women delivering their babies between 1 April 1995 and 31 October 1995. Contacts with PHCT members were recorded up to the 42nd day after delivery, together with their assessment of the subjects' mental health. RESULTS: Of 30 women scoring > or = 12 on the EPNDS, only 13 were perceived to be depressed by the PHCT. The team as a whole identified more depressed women than any individual professional group. There was no significant difference in the number of contacts made with professionals by women who were or were not depressed. Asian women were more likely to be depressed than women from other ethnic groups. CONCLUSION: Despite the PHCT as a whole identifying more depressed women than any individual group, more than half were not identified by professionals. Tools such as the EPNDS should be used routinely in primary care; there is an urgent need to validate the EPNDS for non-Caucasian women.