With medical guidelines for obstetrics and gynecology departments set to be revised next year, the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG) have indicated that they plan to include concrete measures to address postpartum depression.
The new initiative will involve taking steps toward the early identification -- either during pregnancy or immediately following childbirth -- of women who are at risk of contracting postpartum depression. The condition is said to affect one out of every 10 women who give birth, with affected individuals being at risk of abusing or neglecting their children, or even committing suicide.
Existing medical guidelines in the area of obstetrics and gynecology, however, go only as far as to advise that "care be exercised since mental disturbances can easily occur."
A joint panel was set up in April last year by JSOG, JAOG and the Japanese Society of Perinatal Mental Health to analyze and report on the total numbers of postpartum depression cases both domestically and overseas. Moreover, the panel has studied the efforts being taken to address the issue in the United Kingdom, a region regarded as advanced in terms of mental care for expectant and nursing mothers.
The report drawn up by the panel mentions the importance of checkups by obstetricians and gynecologists during the early stages of pregnancy and shortly after childbirth. It further notes that women who are likely to experience postpartum depression can be identified more effectively by including questions during the first prenatal medical interview about whether or not they have a history of depression or schizophrenia, are suffering from partner abuse, and/or have a history of self-harm.
In addition, the report advises that mental checkups be undertaken two weeks and also one month after birth. Concretely speaking, it proposes the utilization of two separate questionnaires -- one of which is the Edinburgh Postnatal Depression Scale (EPDS) from Great Britain, which has come into wide use internationally.
The report further recommends that women who are identified during pregnancy or following childbirth as being at a high risk for postpartum depression be referred to a psychiatrist and be encouraged to seek professional care.
"Through early-stage detection of expectant or nursing mothers who are at risk of postpartum depression, as well as the provision of professional support, serious cases including those of suicide and abuse can probably be reduced," comments Satoru Takeda, a professor with the Department of Obstetrics and Gynecology at the Juntendo University Faculty of Medicine, who serves as JSOG's executive director.
"It will be necessary for obstetricians and gynecologists to engage in close mutual communications with psychiatrists," Takeda adds.
Content of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire:
Please select the answer that comes closest to how you have felt in the past 7 days*:
1) I have been able to laugh and see the funny side of things.
2) I have looked forward with enjoyment to things.
3) I have blamed myself unnecessarily when things went wrong.
4) I have been anxious or worried for no good reason.
5) I have felt scared or panicky for no very good reason.
6) Things have been getting on top of me.
7) I have been so unhappy that I have had difficulty sleeping.
8) I have felt sad or miserable.
9) I have been so unhappy that I have been crying.
10) The thought of harming myself has occurred to me.
* Respondents are asked to select one answer for each question from among four possible responses ranging from the positive to the negative. Their total score is then used in order to evaluate their condition.