How to Screen Postpartum Patients for Perinatal Depression
How should clinicians use a smartphone-based workflow to screen postpartum patients for perinatal depression over the first 6 weeks after delivery?
Postpartum patients often miss office follow-up, and perinatal depression symptoms frequently go unrecognized during a period when mental health morbidity is clinically consequential. This guide applies to postpartum women being monitored by smartphone during the first 6 weeks after delivery and outlines the screening sequence used to identify patients who may need further mental health evaluation.
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Enroll eligible postpartum patients at care transition
Offer smartphone-based monitoring to postpartum women who are at least 18 years old, have delivered a liveborn infant, are proficient in English, own a smartphone, and agree to download the app. In this study, implementation occurred after enrollment during the delivery hospitalization, and the authors note that an mHealth tool like MOMitor can be initiated at the initial prenatal visit or at delivery hospitalization.
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Set a fixed 6-week assessment schedule
Monitor patients for 6 weeks postpartum using ecological momentary assessment at predetermined intervals. The schedule used here was 3 assessments per week during postpartum weeks 1 to 2 and 1 assessment per week during postpartum weeks 3 to 6, with at least weekly mental health assessment throughout the study period.
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Start each early assessment with the mood prescreener
Begin the mental health assessment with the single prescreening question, Overall, are you feeling happy or sad? During postpartum weeks 1 and 2, patients who answered sad were asked to complete the Edinburgh Postpartum Depression Scale, while those who answered happy were not.
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Administer the EPDS universally after week 2
From postpartum weeks 3 through 6, administer the Edinburgh Postpartum Depression Scale to all patients regardless of whether they answered happy or sad on the prescreener. This matters because the single-item prescreener functioned as a triage tool rather than a replacement for the EPDS, and some patients with positive EPDS screens still reported feeling happy.
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Interpret the prescreener as triage rather than diagnosis
Do not rely on the single-item mood question alone to rule out perinatal depression. Using EPDS score 12 or higher as the reference standard, the prescreener had 65.7% sensitivity, 92.6% specificity, 54.2% positive predictive value, 95.3% negative predictive value, and 89.5% overall accuracy.
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Use positive EPDS thresholds to trigger follow-up
Treat an EPDS score of 12 or higher as a positive screen requiring follow-up. Any endorsement of self-harm on EPDS question 10 should also trigger follow-up regardless of the total EPDS score.
Clinical Considerations
- The single-item happy-or-sad prescreener missed a meaningful share of positive EPDS screens and should not replace a validated screening instrument.
- Prescreener sensitivity was higher in postpartum weeks 1 and 2 than in weeks 3 through 6, but the early estimate is affected by the fact that happy respondents did not complete the EPDS in that window.
- The study monitored patients only through 6 weeks postpartum even though postpartum depression can occur up to 1 year postpartum.
- Generalizability is limited because non-English speakers and patients without smartphones were excluded.
Bottom Line
Use the single mood question only to triage early postpartum assessments, but administer the EPDS universally after postpartum week 2 because validated screening remains necessary to detect perinatal depression.
