A cross-sectional study published online March 23 in BMC Psychiatry suggests the importance of evaluating for postpartum anxiety in addition to postpartum depression.

"Postnatal depression has received considerable research and clinical attention, however anxiety and stress in the postpartum has been relatively ignored," write Renée L. Miller, from the Swinburne University of Technology in Hawthorn, Victoria, Australia, and colleagues. "Along with the widespread use of the Edinburgh Postnatal Depression Scale (EPDS), depression has become the marker for postnatal maladjustment. Symptoms of anxiety tend to be subsumed within diagnoses of depression, which can result in anxiety being minimized or overlooked in the absence of depression."

As part of a larger cross-sectional study, 325 primiparous mothers were evaluated with the EPDS and the Depression, Anxiety and Stress Scales (DASS-21). Mothers ranging in age from 18 to 44 years (median, 32 years) whose babies were aged between 6 weeks and 6 months were recruited through mother's groups and health centers in Melbourne, Australia.

Based on a cut-off of more than 9 on the EPDS, 80 women (25%) were possibly depressed. The DASS-21 corroborated depression in 58% of these women. In the total sample, the DASS-21 identified depression in 61 women (19%). When broader criteria for distress were used, the DASS-21 identified an additional 33 women (10%) with symptoms of anxiety and stress without depression, and a total of 41 women (13%) with symptoms of anxiety either alone or combined with depression.

Based on the DASS-21, 7% of the sample was diagnosed with both anxiety and depression. Women in this subgroup had higher mean EPDS and DASS-21 depression scores than did women with depression but without anxiety.

"The prevalence of anxiety and stress in the present study points to the importance of assessing postnatal women for broader indicators of psychological morbidity than that of depression alone," the authors write. "The DASS-21 appears to be a useful instrument for this purpose."

Study limitations include recruitment from mothers' groups and health centers by placing posters rather than by approaching individual women directly; high proportion of tertiary educated women; possible self-selection bias; and lack of formal diagnostic structured interview to provide a "gold standard" against which to validate the DASS-21.

"For as long as the focus of postnatal maladjustment is on depression, failure to identify and treat significant symptoms of anxiety and stress may leave women vulnerable to worsening symptomatology," the authors conclude. "Untreated maternal distress can have a substantial impact on the well-being of the mother, her relationships, and her infant. The DASS-21 is a brief, easy to administer inventory that may assist practitioners (along with clinical interviews) to more effectively assess and treat new mothers who may be depressed, anxious and/or stressed in the postpartum."

An Australian Postgraduate Award supported this study. The authors report no relevant financial relationships.