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For the sake of pre-emptive child protection it is necessary to recognise s of postpartum depression PPD in pregnant women and young mothers as early as possible and to initiate adequate assistance. Because of their high acceptance, especially in the phases of pregnancy and birth, the local gynaecologists offer ideal prerequisites for access to the parents.
This study evaluates the current status of diagnosis and management of PPD in gynaecological practices. The questionnaire addressed their approaches to the diagnosis and management of PPD as well as the encountered barriers.
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A need for improvement in the management of women with PPD was recognised equally often. As barriers the gynaecologists mentioned above all the lack of time, the low reimbursements for consultations and the lack of effective treatment options. Predictors for an active anamnesis were found to be female gender of the gynaecologist, possession of an additional psychosomatic qualification and practice located in an urban catchment area or state of the former West Germany.
The clearly demonstrate a high acceptance for the management of PPD by gynaecologists as well as the need for further frauenarzt hessen center to improve the care of patients with PPD in gynaecological practices. In Germany von Ballestrem et al. Postpartum or postnatal depression or PPD, coded in ICD as a mild mental and behavioural disorder in childbed, not classified elsewhere F PPD is often identified as a predictor for attachment disorders 6infanticide 7developmental disabilities 8 and a later depressive disease of the child 9.
With regard to PPD in Germany there is a clear management deficit due to the lack of psychotherapeutic options for mothers with new-born babies. PPD often le to a feeling of shame among the afflicted mothers, they fear stigmatisation, separation from the baby or they are not consciously aware of their disorder or the available possibilities for help According to the study of Le Strat et al.
Since as yet no highly promising have been achieved for the primary prevention of PPD 14the early recognition and treatment of PPD is especially important Since the afflicted frauenarzt hessen center are often not able on their own to describe their psychological problems, a frauenarzt hessen center active handling of psychological disorders in the period of pregnancy and after birth is particularly important On of their sensitivity and specificity as confirmed in a meta-analysis 21the EPDS and the Patient Health Questionnaire PHQ; 22 are recommended as screening tools for PPD after birth in the S3 guidelines for unipolar depression consultation version During the childbed period in which the PPD symptoms frequently occur for the first time, together the midwife and the gynaecologist are the primary contact persons for the young mother and play a ificant role in the earliest possible recognition of PPD and, if necessary, referral of the afflicted patient during pregnancy and in the first six to twelve months after birth to psychotherapeutic services, for example, as part of the post-natal care The recognition and treatment of pregnancy-related psychological diseases such as PPD is as yet in Germany not a regular component of general medical education or specialist training in the field of gynaecology and obstetrics.
In this German nation-wide survey of local gynaecologists the following questions were posed: What diagnostics do gynaecologists in Germany carry out for pregnant women and mothers with a suspicion of PPD? What management possibilities do gynaecologists see for patients with PPD?
In a first step every third practice ordered according to post code was selected and from this sample in a second step every 12th practice as well as those practices that had already participated in a preliminary study were excluded Fig. In contrast to the German Medical Association, the address provider service uses only public sources for address research in accord with the Federal Data Protection Law so that, for example, the closing of medical practices may have been recorded only after a delay of several months.
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Flow diagramme of the participants in the German nation-wide survey of practicing gynaecologists. Reasons for non-participation such as, for example, closure of the practice were acquired by means of a pre-stamped postcard sent with the second letter that could be returned gratis by the non-participants. In addition, demographic data about the non-participant could be extracted from the practice stamp on the postcard, e. For this survey of practicing gynaecologists a questionnaire encompassing 28 items was used, it was developed on the basis of the findings from surveys of comparable samples e.
The questionnaire contained details of a practice and person, b diagnostics and handling of patients with a suspicion of PPD as well as c system- and patient-related barriers to management in both open and closed answer formats. Multiple answers were possible for many items.
Demographic data for the participating gynaecologists were compared with representative data for the registered gynaecologists in Germany 24 Table 1. Male and gynaecologists aged more than 50 years are underrepresented in the sample.
The non-participants differed ificantly with regard to gender and practice from the participants in this nation-wide survey; with regard to location in the old or new federal states there was no ificant difference between the participants and the non-participants. Thus, it can be assumed that these physicians were still recorded in the address database of the address service provider due to a delayed data actualisation. This may in part explain the difference in physician statistics. For an assessment of the representativeness of the present cross-sectional survey, three factors that could limit the representativeness of the survey were examined:.
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Under consideration of the preformed target group definition, the procedure chosen to select the sample and a comparison of the observed characteristics of the sample with the characteristics of the target population or, respectively, the non-participants it can be assumed that the sample is very probably representative with regard to the regional distribution between the new and the old federal states for the registered gynaecologists in Germany at the time of the survey in the Spring of The of the survey were analysed descriptively.
In order to determine the outcome-influencing factors in the performance of an active diagnosis and consultation in cases of PPD, binary logistic regressions were undertaken. More than half of the participating gynaecologists reported the use of more than one method to detect evidence for PPD. Further barriers mentioned frequently are the lack of psychotherapy places, long waits, communication frauenarzt hessen center and anxiety from stigmatisation and shame.
An active PPD anamnesis, i. It can be seen that an active diagnosis for PPD is more often performed when the physician is female, possesses an additional psychosomatic qualification, and has a practice in an urban catchment area or in the old federal states. In the S3 guidelines for unipolar depression 23this observation has recently been taken into consideration by the extension and differentiation of the recommendations for the recognition and treatment of PPD thus placing PPD more strongly in the field of view of physicians and psychologists.
The present survey was intended to illustrate the health-care situation for mothers with PPD in Germany from the point of view of registered gynaecologists.
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This result can be taken as an indication of the great sensitivity and expertise of gynaecologists for PPD. It can be assumed that standardised PPD diagnostics in gynaecological practices would enable a more reliable detection of patients with psychological disorders.
For an adequate management of PPD a cornerstone could be a screening e. It was found, however, that only half of the surveyed gynaecologists actively looked for PPD. While an active diagnostic procedure was used only by a minority of the gynaecologists, in cases of recognition of PPD the majority of the gynaecologists do, in accord with the guidelines, undertake a consultation or make a referral to other facilities.
Even when the clarified variance is rather small due to the predictors employed in the model, it can be deduced from this survey that PPD is more frequently addressed actively when the gynaecologist is female, has a practice in the old federal states, in an urban catchment area and possesses an additional qualification. Besides the possession of an additional qualification, a consultation is associated with the of system-related barriers.
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The lower amount of active diagnostics in the new federal states could be due to the lower density of physicians there 27which le to a larger of patients to be cared for and thus less time available per patient Also in rural regions there is often a shortage of physicians An additional qualification, e. Above all, structural barriers such as the lack of time for consultations, the low reimbursement for consultations and the lack of effective treatment and care options were mentioned.
Content, quality and efficacy of consultations and referrals were not addressed within the framework of this survey. Similarly, aspects that could improve the predictive strength of the model for active diagnostics and counselling in suspected cases of PPD were not considered since they have already proved to be relevant for the prediction for screening and treatment in PPD e.
The non-participant analysis showed that there were ificantly more men and frauenarzt hessen center gynaecologists in one-person practices in the group of non-participants than in the participant group. In addition to the usual selection effects for participation in voluntary surveys, this could be due to interest and attitudes as well as possible answering tendencies in the direction of social desirability that led to selection effects among the investigated population with regard to attitudes and the mentioned procedures.
The diagnosis and care of patients with PPD in the framework of gynaecological management is already accepted as one of their tasks by many registered gynaecologists in Germany. Empirical studies are needed to check the efficacy of this strategy.
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Conflict of Interest None. National Center for Biotechnology InformationU. Journal List Geburtshilfe Frauenheilkd v.
Geburtshilfe Frauenheilkd. WendtS. RausM. Shedden-MoraO. Wlodarczykand M. Author information Article notes Copyright and information Disclaimer. Correspondence Dr. Associated Data Supplementary Materials German version of this article. Abstract Theoretical Background and Current Issues: For the sake of pre-emptive child protection it is necessary to recognise s of postpartum depression PPD in pregnant women and young mothers as early as possible and to initiate adequate assistance.
Conclusion: The clearly demonstrate a high acceptance for the management of PPD by gynaecologists as well as the need for further action to improve the care of patients with PPD in gynaecological practices. Key words: postpartum depression, gynaecologists, pregnancy, screening, representative survey.
Open in a separate window. Instruments For this survey of practicing gynaecologists a questionnaire encompassing 28 items was used, it was developed on the basis of the findings from surveys of comparable samples e.