Making the case for introducing screening for perinatal psychiatric disorders is not without problems. The case is not helped by the common use of ‘postnatal depression’ as a catch-all term for a variety of conditions, from mild and transient mood lability to some of the most severe psychiatric disorders seen in clinical practice. ‘Screening for perinatal depression’ means different things to different people and it is appropriate to begin by asking screening by whom, for what and when? To its credit, this book considers both antenatal screening for women currently well but at risk of perinatal mood disorder, and screening women for current affective symptoms.
The book, at least in part, can be seen as a response to the controversial decision of the UK National Screening Committee not to recommend the introduction of routine screening for postnatal depression using the Edinburgh Postnatal Depression Scale. A number of different perspectives are brought to the table - a large number of professional groups are represented from both academic and clinical backgrounds. The individual chapters range widely from those describing clinical services, outlining individual research projects or providing personal experiences of accessing services, to those taking a more philosophical overview of the issues involved. In particular the book benefits from a final chapter, written by the editors, responding to many of the issues raised in the previous chapters and summarising the areas of agreement and those that remain in dispute. There is much of interest here to those from a wide variety of professional backgrounds, and the book should have wider appeal than merely perinatal ‘anoraks’ like me.
One recurring theme is a lack of research evidence - reflected by the fact that a number of chapters rely on a description of local services. It also becomes clear that the title is a misnomer - the important perinatal psychiatric conditions are wider than major depression and, particularly when screening for women at risk, include bipolar and schizoaffective disorders.
A philosophical divide is clear - between those who see postnatal depression as an underdiagnosed illness that, without recognition and treatment, can result in long-term negative consequences for a woman and her family, and those who believe that a diagnosis of postnatal depression is the imposition of an inappropriate medical model on the suffering of women at this time of difficult role transition. In his forword, John Cox expresses the hope that the book will be a ‘constructive dialogue’ between the different perspectives. Judged on this criterion, I think it can be considered a success.
eLetters
No eLetters have been published for this article.