PMH-C Postpartum Depression 5 — Questions and Answers
Question 1: A postpartum woman presents with depressed mood, guilt, and fatigue but also reports significant panic attacks and constant worry about her infant's health. Which specifier would be MOST appropriate to add to her diagnosis?
- With melancholic features
- With atypical features
- With anxious distress (Correct answer)
- With peripartum onset
Correct answer: With anxious distress
The 'with anxious distress' specifier is applied when MDD is accompanied by prominent anxiety symptoms such as tension, panic, or excessive worry about losing control.
Question 2: Which of the following populations has a HIGHER-than-average prevalence of postpartum depression?
- Women with planned pregnancies and strong social support
- Women with prior history of depression or anxiety (Correct answer)
- Multiparous women with previous uncomplicated deliveries
- Women in high-income households with flexible work arrangements
Correct answer: Women with prior history of depression or anxiety
A prior personal history of depression or anxiety is one of the strongest individual risk factors for developing postpartum depression.
Question 3: During a home visit, a public health nurse notices a 4-month-old appears underweight and the mother with PPD reports she 'forgets' to feed the baby. What is the MOST appropriate immediate action?
- Provide breastfeeding education only
- Increase the frequency of check-in calls
- Report suspected neglect and coordinate with child protective services and mental health services simultaneously (Correct answer)
- Advise the mother to use formula instead of breastfeeding
Correct answer: Report suspected neglect and coordinate with child protective services and mental health services simultaneously
When PPD leads to infant neglect (failure to meet basic nutritional needs), the clinician has a mandatory reporting obligation alongside coordinating mental health intervention.
Question 4: A postpartum patient of Asian descent minimizes her depressive symptoms, stating it would bring 'shame to the family' to seek psychiatric help. Which barrier to care does this BEST represent?
- Lack of insurance coverage
- Cultural stigma associated with mental illness (Correct answer)
- Inadequate symptom severity
- Geographic access barrier
Correct answer: Cultural stigma associated with mental illness
Cultural stigma, particularly in collectivist cultures where mental illness may reflect on the family unit, is a major barrier to PPD treatment-seeking.
Question 5: A mother at 10 weeks postpartum reports her PPD symptoms are worsening despite 6 weeks on sertraline 50mg. What is the MOST appropriate clinical next step?
- Discontinue sertraline and switch to psychotherapy only
- Increase sertraline dose and reassess in 4 weeks (Correct answer)
- Add a benzodiazepine for long-term management
- Discharge from care as the medication trial has failed
Correct answer: Increase sertraline dose and reassess in 4 weeks
When a therapeutic response is inadequate after an adequate trial, dose titration is appropriate; sertraline can be increased up to 200mg, and reassessment in 4 weeks is standard practice.
Question 6: Which statement BEST describes the relationship between postpartum depression and postpartum psychosis?
- They are the same condition at different severities on a continuum
- Postpartum psychosis is a distinct psychiatric emergency separate from PPD (Correct answer)
- Postpartum psychosis always develops from untreated PPD
- They share the same treatment protocols
Correct answer: Postpartum psychosis is a distinct psychiatric emergency separate from PPD
Postpartum psychosis is a distinct psychiatric emergency characterized by psychosis, hallucinations, and rapid onset, and is not simply a severe form of PPD—it requires emergency psychiatric care.
Question 7: Which of the following is an example of a trauma-informed approach when treating a postpartum woman with PPD who also has a history of sexual trauma?
- Avoid discussing trauma to prevent retraumatization
- Ask about trauma history during the first intake session in a group setting
- Normalize her experience, establish safety and choice, and avoid triggering clinical procedures without consent (Correct answer)
- Require trauma processing before addressing PPD symptoms
Correct answer: Normalize her experience, establish safety and choice, and avoid triggering clinical procedures without consent
Trauma-informed care emphasizes establishing safety, transparency, and patient choice—particularly around clinical procedures like pelvic exams—to avoid retraumatization while treating PPD.
PMH-C Postpartum Depression 5
A postpartum woman presents with depressed mood, guilt, and fatigue but also reports significant panic attacks and constant worry about her infant's health.
Which specifier would be MOST appropriate to add to her diagnosis?