PMH-C Assessment and Screening 2 — Questions and Answers
Question 1: A postpartum patient scores 13 on the Edinburgh Postnatal Depression Scale (EPDS). Which action is most appropriate?
- Reassure the patient and reschedule in 4 weeks
- Conduct a full clinical assessment and create a safety plan (Correct answer)
- Immediately refer to inpatient psychiatric care
- Prescribe an antidepressant without further evaluation
Correct answer: Conduct a full clinical assessment and create a safety plan
An EPDS score of 13 or above indicates likely depression and warrants a thorough clinical assessment including safety planning.
Question 2: Which EPDS item specifically screens for suicidal ideation?
- Item 7 — difficulty sleeping
- Item 10 — thoughts of self-harm (Correct answer)
- Item 5 — fear or panic
- Item 3 — blaming oneself unnecessarily
Correct answer: Item 10 — thoughts of self-harm
Item 10 of the EPDS asks directly about thoughts of harming oneself and must always be reviewed regardless of total score.
Question 3: The GAD-7 is most commonly used in perinatal settings to screen for which condition?
- Postpartum psychosis
- Generalized anxiety disorder (Correct answer)
- Bipolar I disorder
- Post-traumatic stress disorder
Correct answer: Generalized anxiety disorder
The GAD-7 (Generalized Anxiety Disorder 7-item scale) is validated to screen for generalized anxiety disorder in perinatal populations.
Question 4: A clinician is assessing a pregnant patient at 28 weeks with a history of childhood trauma. Which screening tool is most appropriate for PTSD?
- PHQ-9
- EPDS
- PC-PTSD-5 (Correct answer)
- AUDIT-C
Correct answer: PC-PTSD-5
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a brief, validated tool appropriate for identifying PTSD in perinatal primary care settings.
Question 5: When is the optimal time to administer the EPDS during the postpartum period for best clinical utility?
- Within 24 hours of delivery
- At the 2-week and 6-week postpartum visits (Correct answer)
- Only at the 6-month well-baby check
- At 12 months postpartum only
Correct answer: At the 2-week and 6-week postpartum visits
Administering the EPDS at both the 2-week and 6-week visits maximizes detection because perinatal depression can emerge at different time points.
Question 6: Which factor most significantly increases false-negative results when using self-report screening tools like the EPDS in perinatal populations?
- High health literacy
- Stigma about mental illness causing underreporting (Correct answer)
- Screening during the third trimester
- Presence of a support person during completion
Correct answer: Stigma about mental illness causing underreporting
Stigma surrounding mental illness often leads patients to underreport symptoms, increasing false-negative rates on self-report tools.
Question 7: A clinician administers the EPDS to a patient who recently immigrated from a non-English-speaking country. What is the most important consideration?
- The EPDS has not been validated in any language other than English
- Use a validated translation and consider cultural interpretation of symptom expression (Correct answer)
- Skip screening until the patient is more comfortable with English
- Administer the PHQ-9 instead, which has universal cultural validity
Correct answer: Use a validated translation and consider cultural interpretation of symptom expression
Validated translations of the EPDS exist in many languages, but clinicians must also consider cultural variation in how distress is expressed and interpreted.
PMH-C Assessment and Screening 2
A postpartum patient scores 13 on the Edinburgh Postnatal Depression Scale (EPDS).
Which action is most appropriate?