Postnatal Depression Intervention Programme

Maternal healthcare in Singapore traditionally focused on obstetric needs of pregnant women. Postnatal depression can affect not only maternal well-being, but also child development. Infants of depressed mothers are at risk of adverse emotional and cognitive development. With postnatal depression affecting about 1 in 12 local women, there is a need for early detection and intervention of postnatal mental illness amongst Singaporean mothers to improve outcomes for both mother and child.

In KKH, the Postnatal Depression Intervention Programme was initiated in April 2008, and it consists of two phases:-

• Screening Phase: Using the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool, women returning for postnatal review at selected KKH clinics are assessed for postnatal mental illness and provided appropriate care plans.
• Intervention Phase: Women identified as at-risk are provided counseling support and phone follow-up care. The high-scorers identified as possible cases are entered into ambulatory clinical intervention using a case management model. Incorporating multidisciplinary team input was provided as needed for each individual case, as well as support group intervention.

Outcome measures include improvement in scores on the EPDS scores, Global Assessment of Functioning (GAF), EQ-5D health quality scores, as well as Patient Satisfaction measures. We found that screening for postpartum depression was acceptable to the majority of women, with 412 women identified as probable cases (EPDS>12) from 3084 women (13.4%). Of these, 84 accepted intervention, and about 91.5% have shown improvement as measured by 20% reduction in EPDS scores, about 93.5% have shown improvement in functioning as measured by GAF scores, and 91.1% have improved health quality as measured by EQ-5D scores. The screening and intervention programme was also well-accepted by women as reflected by the satisfaction measures.

Preliminary results from our pilot programme targeting early detection and intervention of Postnatal Depression show beneficial results and are considered sustainable. The programme has been open to accept non-KKH referrals, as it has been concurrently extending education awareness efforts into the community. The team is also gathering research in this area to better inform and improve care.

Outcome measures: