partum anxiety, Dr. Tobia stated yes. The Edinburgh Postnatal Depression
Scale (EPDS), which is routinely filled out by women after they deliver,
also may be used as a multi-dimensional tool to screen for anxiety
disorders in addition to depression (Matthey et al, 2012). Through
this questionnaire, if the woman is found to have depression and/or
anxiety that is causing significant distress, this response should
generate a referral for mental health counseling, Dr. Tobia noted.
three questions (the EPDS-3A) among perinatal women with different
diagnoses and discovered a consistent pattern, in which the total
EPDS scores correlated with the presence of anxiety.
identified with anxiety disorders. Four of these six studies interpreted
results as supporting the use of the total EPDS score to differentiate
between women with depression and women with anxiety. Two of
the six studies identified a cut-off score for the EPDS-3A that could
be used to identify women with different anxiety disorders,
Dr. Tobia said.
the EPDS-3A, a psychiatric evaluation would distinguish between
whether they are experiencing anxiety or depression, he explained.
A potential problem with using only the overall EPDS score is the
fact that women with anxiety may not have high overall scores and
consequently may not be flagged for referral. Reducing the cut-off
to generate psychiatric consultations from an overall score of 10
or above to eight or above (and high on the EPDS-3A) may
help address that limitation, Dr. Tobia suggested.
fense mechanisms such as suppression among postpartum women
experiencing anxiety. One such method is through the use of uncon-
ditional positive regard and support for the new mothers. The answer
to what this is, and how practitioners can use it, is embedded in the
idea of empowerment, Dr. Tobia said. The best ways to empower a
patient, he explained, are to:
J. Gregory Carroll's E4 model for physician-patient communication,
with patients:
if possible.
"yes, something is bothering me," the answer is still yes; probe fur-
ther. If the health care team members only take the patients verbatim
and don't ask further questions, they may miss what might be vital
clinical symptoms. If the clinician is looking at the computer, then the
patient may not speak as freely. Clinicians may have to decide
patient management on the patient's spoken word, said Dr. Tobia.
communication and bedside manners should be part of patient-
centered care courses at any medical school, he stressed. Rutgers
Robert Wood Johnson Medical School features a strong patient-
centered care curriculum, including a course in bedside manners that
focuses on gaze (look at the patient equally when talking and
listening), facial movements and expressions (face patients directly),
head movements (use facilitative nodding when listening), body
movements/posture, interpersonal distance, angle of orientation
toward the other, interpersonal touch, and voice (speak at a similar
speed and volume to the patient's).
improvements in medical history taking, clinical judgment, accurate
diagnoses, and cost-effective prescribing, Dr. Tobia said. Continued
education assists in improving all aspects of patient care. This is
especially important on the obstetrical service.