Case Examples
L.F. is a 24-year-old woman with no signifi cant risk factors
for PPD, who is two weeks postpartum. The EPDS she
took just two days after delivering her baby in the hospital
prevention of postpartum depression
The Journal of Lancaster General Hospital • Winter 2008–2009 • Vol. 3 – No. 4 149
was not signifi cantly elevated with a score of 6/30. At
4 days postpartum, she fi nds herself tearful. In response
to this, her husband comforts her and reassures her. She
has two more brief episodes of sadness and tearfulness,
both of which are met with support from her husband
and other family members. At two weeks, she has had no
repeat episodes, looks bright, has confi dence in herself as
a new mother and enjoys her supportive family. When
she relays this experience to her daughter’s pediatrician,
he administers the EPDS, which is not clinically
signifi cant with a score of 2/30. At her 6 week follow-up
with her obstetrician, he diagnoses her with an episode
of postpartum blues.
This case illustrates a woman who has no known risk
factors for PPD, a negative screen in the immediate
postpartum period, and mild depressive symptoms of
short duration that resolve by two weeks postpartum. Her
obstetrician appropriately diagnoses her with an episode
of postpartum blues.
M.L. is a 29-year-old woman with no pre-existing
risk factors for PPD who is one week postpartum. She
obtained a positive screen of 10/30 when the EPDS
was administered in the hospital 2 days postpartum.
In the well-baby visit she reports being very worried
about the health of her baby boy. She described not
being supported by her spouse, who seems to be absent
most of the time. He often is critical of her abilities as a
new mom. Her son’s family doctor attempts to reassure
her, but she continues to exhibit a pre-occupation with
worry when her son is in good health. The doctor asks
her how she has been feeling, and she says “fi ne.” She
denies having depression. He then gives her an EPDS to
complete as a follow-up to her previous positive score.
He fi nds that her score again is signifi cantly elevated
at 12/30, with the endorsement of items related to not
fi nding enjoyment, self-blame, anxiety, panic, and sleep
disturbance. Recognizing how the mother’s health can
affect the baby’s health and well-being, the doctor then
educates her regarding PPD, provides her with a list of
community resources, and refers her to a psychologist for
a comprehensive evaluation.
This case describes a woman, with lack of support and
strain in her marital relationship (i.e., a risk factor for
PPD), who is having symptoms of PPD that are predominantly
anxiety-based. While she is reluctant to
endorse or perhaps does not recognize “depression,” a
formal screening identifi es an increased likelihood for
PPD. Now with two positive screens and one risk factor
for PPD, appropriate follow-up is taken, including
education, community support and a referral for a more
comprehensive evaluation.