Are we overpathologising motherhood?

Abstract

Background: The rate of psychiatric disorders in motherhood is often estimated on the percentage of women scoring high on validated self-report mood measures such as the Edinburgh Depression Scale. Screening for possible current or likely future distress also uses self-report mood measures, as well as additional psychosocial questions.

Methods: This paper critically questions whether such prevalence rates, and percentage of women with high risk status following screening, are being overestimated. The properties of the Edinburgh Scale are examined, along with the validity of diagnostic criteria. In addition a consideration as to the percentage of women classified as 'at-risk' is considered.

Results: The properties of the Edinburgh Scale show that around 50% of women scoring high are not in fact depressed. Revised estimates of prevalence rates are therefore given that take the properties of the scale into account which are more conservative than current estimates. Repeat testing of the scale after just two weeks to help differentiate transient from enduring distress will also lower the possibility of overpathologising motherhood, as will the use of correct cut-off scores. The DSM IV diagnostic criteria for depression are also questioned in relation to perinatal women and men. Finally, classifying women to be 'at-risk' based upon the presence of a single risk factor is questionable given that the majority of women with risks do not become depressed, and also the rate of women reported to have at least one risk (up to 88%) is so high as to negate the usefulness of this concept.

Conclusions: Current estimates of the prevalence of perinatal distress, and of women with risks, are an overestimation of the true rates. The clinical practice of using the presence of a single risk factor, or a single high score on a self-report mood scale, to form part of the assessment to determine whether or not to actively intervene may also overpathologise the situation. A more thorough understanding of these issues will improve our assessment procedures so that resources can be appropriately targeted to those women, and their families, who really need specialist mental health intervention.