A system for flagging postpartum depression

Around 10-15% of all new mothers experience postpartum depression.

It is extremely stressful for both mother and baby, partly because depression of this kind has an adverse effect on the bond between the two and, in the worst case, may ruin it. This poses a threat to the child’s well-being and mental development. It therefore makes good sense to attempt to prevent postpartum depression.

We will know whether this can be done in a few years’ time, once Trine Munk-Olsen, senior researcher at The National Center for Register-based Research, Aarhus University, has completed the project she will soon be starting with funding from the Lundbeck Foundation.

Trine Munk-Olsen explains that she will be conducting the project in close collaboration with iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research, and its aim is to develop a risk model:

‘Risk models are tools that are widely used in the prevention of diseases such as cancer, cardiovascular disorders and diabetes – and the models work when it comes to identification and offering preventive measures and help to individuals at high risk of developing certain somatic diseases. The risk models for psychiatry – the field to which postpartum depression belongs – are not yet sufficiently well-developed to be used in clinical practice. But I believe they could be applied to postpartum depression. And I’ll be starting work on their development together with some of my colleagues,’ says Trine Munk-Olsen, who has received a Lundbeck Foundation Ascending Investigators grant worth DKK 5 million.

A mountain of data
In the case of cancer, it is well known that alcohol, tobacco and a fatty diet, lacking in fibre, are some of the lifestyle factors that statistically, together with genetic disposition, increase the risk of cancer.

Trine Munk-Olsen explains that it is much more difficult to be so specific when it comes to postpartum depression:

‘A genetic vulnerability in the mother may play a role. This is borne out, for instance, by a new study I was involved in. But, in general, we lack knowledge about any other potential underlying factors.’

The researchers’ hypothesis is that a range of factors in the mother may play a role, including age, long-term use of psychopharmaceuticals, trauma in early life and depression, pre-eclampsia, premature birth, family structure and socio-economic status.

The difficulty is to determine how these – and other – factors should be weighted as risk factors for development of postpartum depression. And a weighting methodology is necessary if we are to prepare a risk model for postpartum depression similar to those available for numerous other somatic diseases such as cancer and diabetes.

To achieve this, the researchers need to look at a wealth of data from various Danish registers, all of which are connected to the Danish civil registration (CPR) system. These registers include the Medical Birth Registry, the Psychiatric Central Research Register, iPSYCH’s data and the National Patient Registry. Trine Munk-Olsen says:

‘We need to look at data from before and during the women’s pregnancies and from the time around the birth. We have access to this type of information from 2.8 million Danish women who have given birth to at least one child. This is unique and is only possible because Danish legislation allows researchers access to anonymised health data. This means we can track anonymous mothers across the many different CPR-based health registers. We hope this will help us identify particularly significant factors underlying postpartum depression, and that we will be able to use the information to build a risk profile.’

The watchful eye of our health visitors
Health visitors are one of the groups of healthcare professionals with closest contact to pregnant women and new mothers. It will usually be the health visitor who will detect early signs of a new mother developing postpartum depression.

In the Danish system, the health visitor’s home visit when the baby is around two months old includes focus on detecting postpartum depression. Trine Munk-Olsen explains that if there is any suspicion of postpartum depression, the health visitor can ask the mother to fill out a special questionnaire: The Edinburgh Postnatal Depression Scale (EPDS).

‘EPDS can identify symptoms of postpartum depression and, based on this, the mother will be referred to her own GP for examination. So it’s a great tool. The idea behind our risk model is to create a supplementary tool, so that health professionals can provide the relevant support before full-blown postpartum depression develops.’

Trine Munk-Olsen hopes that the risk model will also be able to be applied during pregnancy:

‘We won’t end up with a risk model that will tell us with 100% certainty that this woman will develop postpartum depression. But I’m convinced that we’ll achieve an effective model for identifying the women at high risk.’

 

Facts

*It is scientifically recognised that fathers, too, can suffer from postpartum depression. Fathers are not currently included in Trine Munk-Olsen’s project, but they may be in a later phase.

*Much of the material Trine Munk-Olsen is working with comes from HOPE. This is an international data collection project based on the Edinburgh Postnatal Depression Scale. Trine Munk-Olsen and project coordinator Katja Ingstrup, both from Aarhus University, are responsible for the Danish contribution to HOPE. If you are a mother and would like to take part in HOPE, you can read about the project at www.hope.au.dk

*0.1% of all women who give birth develop postpartum psychosis. Postpartum psychosis is not included in the work to develop a risk model for prevention of postpartum depression.