Depression: 3 Simple Questions

Depression: 3 Simple Questions

Most women with real postpartum depression are never diagnosed. Even though postpartum depression is very common, and even though identifying it can help both the baby and the mother, most cases slip through the cracks. A simple new 3-question test has proven very reliable at detecting postpartum depression. Perhaps surprisingly, none of the questions were about feeling sad, feeling happy, laughing, crying, feeling hopeful or hopeless, or being able to sleep. Nevertheless, the brief 3-question test was able to identify accurately 95 percent of the depressed women in a September 2008 study. It was about as reliable as more involved questionnaires, and much more practical because of its brevity.

The likelihood of postpartum depression usually peaks when the baby is about 12 weeks old, give or take a couple of weeks. I understand that pediatric offices are very busy these days, but I would love to see this 3-question test (or a more extensive one) for moms at every well-baby visit in the first 6-months. Too many moms and babies go through this without the support they deserve.

What are the 3 questions? They focus on a unique and important part of postpartum depression: excess anxiety. Some anxiety for new parents, of course, goes with the territory. Parenthood is, after all, a new adventure into the unknown. You love a new person so much, it’s normal to feel fear and anxiety. But when anxiety or fear predominate your daily experience with a new baby, it can be a sign of postpartum depression.

Here is the test:

As you have recently had a baby, we would like to know how you are feeling. Please underline the answer that comes closest to what you have felt IN THE PAST 7 DAYS, not just how you feel today.

1. I have blamed myself unnecessarily when things went wrong.
a. Yes, most of the time 3
b. Yes, some of the time 2
c. Not very often 1
d. No, never 0

2. I have been anxious or worried for no good reason.
a. No, not at all 0
b. Hardly ever 1
c. Yes, sometimes 2
d. Yes, very often 3

3. I have felt scared or panicky for no very good reason.
a. Yes, quite a lot 3
b. Yes, sometimes 2
c. No, not much 1
d. No, not at all 0

The way I have presented it here, the maximum possible score is 9. Women with a score of 3 or more may or may not be depressed, but deserve further evaluation to be sure. If a cutoff score of 4 or even higher were used, the results would more likely indicate depression, but some depressed women would be missed. The purpose of a screening test is to find those who would benefit from more evaluation. This test has only been validated as a screening tool for moms. Depressed dads are also important to identify, but they may have very different symptoms.

Kabir K, Sheeder J, and Kelly LS. Identifying Postpartum Depression: Are 3 Questions as Good as 10? Pediatrics Sep 2008; 112:e696-702.

*Doctors will usually take the total score and multiply it by 10/3. This way 30 is the maximum possible score, and those with a score of 10 or more should be evaluated. This keeps the score consistent with other postpartum depression test currently in use.

Dr. Alan Greene

Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.

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