PMH-C Postpartum Depression 4 — Questions and Answers
Question 1: A mother reports she began feeling depressed during her third trimester and the symptoms continue at 8 weeks postpartum. How should this presentation be classified?
- Prenatal depression only, since it started before delivery
- Postpartum depression with peripartum onset specifier (Correct answer)
- Adjustment disorder with depressed mood
- Dysthymia
Correct answer: Postpartum depression with peripartum onset specifier
Depression beginning in the prenatal period and continuing postpartum is classified as MDD with peripartum onset specifier, as DSM-5 includes pregnancy-onset presentations.
Question 2: Which sleep intervention is MOST supported by evidence for improving mood in postpartum women with depression?
- Encouraging the mother to sleep only when the baby sleeps
- Coordinated sleep support allowing 4-hour uninterrupted sleep stretches (Correct answer)
- Restricting daytime napping to improve nighttime sleep quality
- Prescribing benzodiazepines for sleep consolidation
Correct answer: Coordinated sleep support allowing 4-hour uninterrupted sleep stretches
Coordinated partner or support person involvement to allow the mother at least one 4-hour uninterrupted sleep stretch significantly improves mood and is evidence-supported.
Question 3: A postpartum client with PPD also has a history of bipolar II disorder. Which treatment consideration is MOST critical?
- Start an SSRI immediately without mood stabilizer
- Avoid all psychotropic medications during breastfeeding
- Use antidepressants only with a mood stabilizer to reduce risk of mood switch (Correct answer)
- Recommend ECT as first-line treatment
Correct answer: Use antidepressants only with a mood stabilizer to reduce risk of mood switch
In patients with bipolar disorder, SSRIs used without mood stabilizers carry risk of precipitating hypomanic or manic episodes, so mood stabilizer co-prescription is essential.
Question 4: Which of the following is a core component of Interpersonal Therapy (IPT) as applied to postpartum depression?
- Exploring unconscious conflicts about motherhood
- Addressing role transitions related to new parenthood (Correct answer)
- Identifying and restructuring automatic negative thoughts
- Practicing mindfulness-based stress reduction techniques
Correct answer: Addressing role transitions related to new parenthood
IPT for PPD specifically targets the role transition to parenthood as a central therapeutic focus, helping mothers navigate identity and relational changes.
Question 5: A postpartum patient declines antidepressants but is willing to try non-pharmacological interventions. Which of the following has the STRONGEST evidence as a non-pharmacological treatment for PPD?
- Omega-3 fatty acid supplementation alone
- Bright light therapy
- Psychotherapy, particularly CBT or IPT (Correct answer)
- Yoga and meditation without structured psychotherapy
Correct answer: Psychotherapy, particularly CBT or IPT
Structured psychotherapy, especially CBT and IPT, has the strongest non-pharmacological evidence base for treating PPD and is recommended as first-line in those declining medication.
Question 6: A nurse practitioner screens all postpartum patients at the 2-week and 6-week well-baby visits using the EPDS. At what score should a full diagnostic clinical interview be initiated?
- Score of 5 or above
- Score of 8 or above
- Score of 10 or above (Correct answer)
- Score of 15 or above
Correct answer: Score of 10 or above
An EPDS score of 10 or above is the commonly accepted threshold that warrants a full diagnostic clinical interview to assess for postpartum depression.
Question 7: Which parenting behavior is MOST directly impacted by postpartum depression and should be assessed as part of a comprehensive PPD evaluation?
- Frequency of pediatric appointments
- Maternal sensitivity and emotional availability during infant interactions (Correct answer)
- Adherence to immunization schedules
- Selection of infant feeding method
Correct answer: Maternal sensitivity and emotional availability during infant interactions
Maternal sensitivity and emotional availability are core attachment behaviors directly impaired by PPD and are critical targets of assessment and intervention.
PMH-C Postpartum Depression 4
A mother reports she began feeling depressed during her third trimester and the symptoms continue at 8 weeks postpartum.
How should this presentation be classified?