Globally identified gaps and recommendations for assessing risk and severity of intrusive thoughts amongst postpartum women in outpatient settings: A systematic review

Abstract

Background: Postpartum mood and anxiety disorders (PMADs) are generally underdiagnosed, often due to the lack of specific maternal mental health training among non-specialty providers. There is little consensus regarding the best practices for assessing postpartum women for intrusive thoughts of infant-related harm, a common PMAD symptom, in these outpatient settings. Objective: To qualitatively review the current published literature to identify the gaps and recommendations for outpatient screening procedures when determining risk and severity of intrusive thoughts. Methods: This paper describes a systematic search of the literature using three electronic databases to locate globally-inclusive studies on PMAD assessments from its inception to March 2020. Results: The search produced 166 eligible studies from 45 individual countries using assessments in 40 distinct languages. A total of 108 individual assessment tools were used, and 80% used the Edinburgh Postnatal Depression Scale (EPDS). Out of the 162 eligible studies, 25 studies directly assessed for intrusive thoughts related to infant-harm.