PMH-C Perinatal Mental Health Disorders & Assessment 4 — Questions and Answers
Question 1: When screening a postpartum patient using the EPDS, which score threshold is most commonly used to indicate possible postpartum depression requiring further assessment?
- Score ≥ 5
- Score ≥ 10 (Correct answer)
- Score ≥ 15
- Score ≥ 20
Correct answer: Score ≥ 10
An EPDS score of ≥10 is the most widely recommended threshold for indicating possible postpartum depression and the need for further clinical evaluation.
Question 2: A woman presents at her 28-week obstetric visit reporting recurrent nightmares, avoidance of pregnancy-related medical appointments, and hypervigilance since a previous pregnancy loss. The most appropriate provisional diagnosis is:
- Major depressive disorder
- Perinatal grief reaction
- PTSD related to prior pregnancy loss (Correct answer)
- Specific phobia of medical procedures
Correct answer: PTSD related to prior pregnancy loss
Re-experiencing (nightmares), avoidance (skipping appointments), and hyperarousal following a traumatic event (pregnancy loss) are hallmark PTSD criteria.
Question 3: Which of the following is a recognized risk factor specifically associated with increased likelihood of developing perinatal depression?
- Primiparity
- Planned pregnancy
- History of depression or anxiety prior to pregnancy (Correct answer)
- Advanced maternal age
Correct answer: History of depression or anxiety prior to pregnancy
A personal history of depression or anxiety is one of the strongest and most consistently identified risk factors for perinatal mood and anxiety disorders.
Question 4: According to the DSM-5, the 'with peripartum onset' specifier for major depressive disorder applies when the episode begins:
- Only during pregnancy
- Only within 4 weeks after delivery
- During pregnancy or within 4 weeks after delivery (Correct answer)
- Within 12 months after delivery
Correct answer: During pregnancy or within 4 weeks after delivery
DSM-5 uses 'with peripartum onset' when a major depressive episode begins during pregnancy or within the first four weeks postpartum.
Question 5: Which of the following best describes the relationship between postpartum depression (PPD) and paternal mental health?
- Paternal PPD does not exist as a clinical entity
- Paternal depression is unrelated to maternal PPD
- Paternal PPD affects approximately 10% of fathers and is correlated with maternal PPD (Correct answer)
- Fathers are at higher risk for PPD than mothers
Correct answer: Paternal PPD affects approximately 10% of fathers and is correlated with maternal PPD
Approximately 10% of fathers experience postpartum depression, and rates increase significantly when the mother also has PPD, suggesting a shared relational vulnerability.
Question 6: A patient at 10 weeks postpartum reports she loves her baby but feels disconnected from the infant, has no energy, and cries daily. She asks, 'Does this mean I'm a bad mother?' The clinician's best response reflects which therapeutic principle?
- Psychoeducation to normalize PPD as an illness rather than a character flaw (Correct answer)
- Reassurance that these feelings will resolve without treatment
- Encouragement to try harder to bond with the infant
- Redirection toward medication without addressing her concern
Correct answer: Psychoeducation to normalize PPD as an illness rather than a character flaw
Psychoeducation that frames PPD as a medical condition rather than a moral failing reduces shame, improves treatment engagement, and validates the patient's experience.
Question 7: Which of the following symptoms is most consistent with perinatal anxiety rather than perinatal depression?
- Persistent sadness and tearfulness
- Excessive worry that feels uncontrollable, even during positive moments (Correct answer)
- Flat affect and emotional numbness
- Loss of interest in previously enjoyed activities
Correct answer: Excessive worry that feels uncontrollable, even during positive moments
Excessive, uncontrollable worry that persists even in objectively safe situations is the hallmark of anxiety, distinguishing it from the persistent sadness and anhedonia characteristic of depression.
PMH-C Perinatal Mental Health Disorders & Assessment 4
When screening a postpartum patient using the EPDS, which score threshold is most commonly used to indicate possible postpartum depression requiring further assessment?