HMOs Join Effort to Detect and Treat Postpartum Depression

Decision to start program - already being implemented as a pilot in Jerusalem - is based on the results of an Israeli study showing a high level of depression among women before and after giving birth.

Dan Even
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Dan Even

The Health Ministry is launching a program to identify women who are depressed during or following pregnancy, by means of health maintenance organizations and well-baby clinics.

The decision to start the program - which is already being implemented as a pilot in Jerusalem - was originally based on the results of a study by Israel's Gertner Institute for Epidemiology and Health Policy Research, showing a high level of depression among women before and after giving birth.

A draft of a circular by the Health Ministry's chief of public health services, Prof. Itamar Grotto, which was distributed recently for comments by experts, explains the basics of the program.

It requires nurses in HMOs and well-baby clinics to perform tests to detect depression in expectant mothers, beginning in the 26th week of pregnancy, as well as among new mothers during their babies' regular one- and two-month checkups.

The test will be administered using the international Edinburgh Postnatal Depression Scale, which includes 10 questions, the answers to which are graded on a scale of 0 to 30. Any response of over 10 indicates a risk of depression, and will require the intervention of specially trained nurses in well-baby clinics and local Health Ministry branches.

Signs of depression include weeping, a feeling of misery, an inability to laugh, a tendency to self-recrimination, anxiety without any apparent reason and suicidal thoughts.

Women in need of treatment will be referred to local public health clinics. However, the waiting list for treatment at such clinics for other conditions is presently six to eight months for an adult. Thus, for the past several months, therapists have been undergoing specific further training, and will receive new and expectant moms diagnosed with depression without a long waiting period.

The initial decade-long Gertner Institute study, led by Saralee Glasser, a developmental psychologist involved in health policy, revealed a particularly high level of depression among expectant moms: 26.5 percent; after birth the figure was 12.7 percent. However, the study was carried out in the 1990s, with the participation of many new immigrant women (in Israel less than two years ).

In 2006, Glasser reassessed the phenomenon, in cooperation with the Clalit HMO, among 6,640 women throughout the country. The results: 14.1 percent of expectant mothers were found to be suffering from depression, while 9.1 percent of new mothers had postpartum depression.

Glasser says that the researchers recommended that the questionnaire not be administered before the baby is four weeks-old so as not to misdiagnose women who are suffering from "baby blues" - a sense of malaise after giving birth that passes after a few weeks.

Pediatricians in Western countries have been asked in recent years to exercise increased vigilance in detecting postpartum depression.

In a study conducted by the Gertner Institute in cooperation with Clalit among 122 pediatricians and 101 family doctors, 90 percent said they believed it was important to notice the symptoms. Seventy percent of pediatricians and 34 percent of family doctors said they believed women at risk should be referred to specialists, while 41 percent of family doctors and 15 percent of pediatricians said they could diagnose the women themselves.

Among pediatricians, 60 percent said they would administer the questionnaires; among family doctors that figure was 82 percent.

In the Beit Shemesh and Mateh Yehuda region letters are already being disseminated to family physicians to encourage them to look for signs of depression among pregnant women and new mothers.

The Health Ministry says: "Research has shown that it is very important to detect depression in pregnant women and new mothers. Depression effects the relationship between the mother and the baby, and can cause developmental delays, sometimes irreversible, and health problems." Moreover, left untreated, the ministry noted, depression can lead a new mother to harm herself or her baby.

"Early diagnosis ensures good health for the woman, the baby and the whole family," the ministry adds.