Initial positive results on a screening instrument such as the Edinburgh Postnatal Depression Scale should be followed by a second screening a week or two later, as well as a thorough assessment of whether new mothers have the risk factors associated with postpartum depression, according to the study's researchers.

Cindy-Lee Dennis, Ph.D., and colleagues recruited 594 new mothers receiving health services near Vancouver, British Columbia, between April 2001 and January 2002 to participate in the study.

The women were recruited through a large group of family physician, obstetrician, and midwifery offices that agreed to be part of the study.

Dennis is an assistant professor of nursing at the University of Toronto and an investigator at the Canadian Institutes of Health Research.

Each of the mothers received a postpartum questionnaire at one, four, and eight weeks after giving birth.

Dennis assessed her subjects for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS), in which scores range from 0 to 30.

In the study, women who had a score greater than 9 were defined as exhibiting depressive symptoms.

The first questionnaire at the one-week mark also assessed risk factors for postpartum depression, including psychiatric, sociodemographic, biological, psychological, and items related to life stressors.

After getting those data, Dennis compared two groups of women—those who tested positive for depression at one week and remained symptomatic at the eight-week mark, and those who tested positive for depression at one week but were not symptomatic at eight weeks.

At one week after giving birth, 175 women (29.5 percent) exhibited depressive symptoms. Of those, 54.8 percent, or 80 women, exhibited depressive symptoms as measured by the EPDS at eight weeks postpartum.

"You must have appropriate and timely treatment in place" for women with postpartum depression.

"Mothers who continued to exhibit depressive symptomatology at eight weeks postpartum had significantly higher levels of perceived stress in the past year, were more likely to have a partner with a drug or alcohol problem, and were more likely to have been sexually abused as a child," the authors wrote.

Women who were depressed at eight weeks were also more likely to have immigrated to Canada recently and perceived having less emotional support from others, including close family members.

Eight weeks after giving birth, 101 of 498 mothers who returned a follow-up survey (20.3 percent) were depressed, according to the findings. Of those 101 women, about 80 percent were also depressed at one week postpartum.

Mothers who exhibited depressive symptoms at one week and at eight weeks had higher levels of perceived stress and a number of stressful life events in the past year as compared with those who were not depressed at one week postpartum. In addition, they had higher reported levels of conflict with their partners.

According to Dennis, asking the women about certain risk factors is one way for physicians to predict more reliably whether mothers who report depressive symptoms at one week will go on to have symptoms months later.

"If the mother's first EPDS score is over 9 and she says she is fighting with her husband, feeling lonely, and perhaps one of her parents recently passed away, her depression will probably continue" if she is not treated, Dennis told Psychiatric News.

Dennis suggested that if physicians screen new mothers early in the postpartum period, they "implement a two-phase screening process" in which they screen new mothers twice using the EPDS.

"Based on the results of the second test, you'd implement some type of treatment protocol" appropriate for the severity of the new mother's depression, ranging from support groups to psychotherapy and medications. Dennis said. Screening without treatment is pointless, she noted.

"You must have appropriate and timely treatment in place" for women with postpartum depression.

Paranoid Thoughts Almost As Common As Depression/Anxiety Reveal King's College Scientists

Ground-breaking research from clinical psychologists at the Institute of Psychiatry, King's College London, shows that one in three people in the UK regularly suffers paranoid or suspicious fears. In fact this level of paranoia is much higher than previously suspected and means that paranoid thoughts may well be almost as common as depression or anxiety.

Paranoid thinking is the suspicion that other people intend to do us harm.

The study found that:


-- over 40% of people regularly worry that negative comments are being made about them
-- 27% think that people deliberately try to irritate them
-- 20% worry about being observed or followed
-- 10% think that someone has it in for them
-- 5% worry that there's a conspiracy to harm them

The research conducted amongst 1200 people highlights the surprising extent of paranoia amongst the UK population, and the distress they can cause. Worries about other people are so common that they seem to be an essential - if unwelcome - part of what it means to be human.

Dr Daniel Freeman, who conducted the study with Professor Philippa Garety at the Institute of Psychiatry, said: “We were astonished at how common paranoia and suspicion are amongst the population and that these thoughts may be almost as common as anxious or depressed thinking. Understandably there are certain instances when it is important to practice caution, such as taking money from a cash machine without alerting too much attention and walking down a poorly-lit street at night. Following last year's London bombings, it is natural that underground train travellers are more vigilant than before. However our research demonstrates that there can be a tendency to exaggerate our fears. Our study shows just how many of us are worrying - probably unnecessarily - about something that might not happen instead of getting on with the more enjoyable and productive parts of our lives.”

“What we also found in our study was that these suspicious thoughts can cause real distress. Our research has highlighted this trend - until recently we had little idea of the extent of the problem, and little sense of how to help people overcome their fears. But the good news is that there are now very effective ways of reducing unfounded suspiciousness.”

Overcoming Paranoid and Suspicious Thoughts

A new website is being launched: www.paranoidthoughts.com which provides information on paranoid thoughts, advice on seeking help, and opportunities for people to share their experiences. Also the results of the research are detailed in the world's first self-help book on dealing with paranoid thoughts published on the 3 July 2006, Overcoming Paranoid and Suspicious Thoughts, published by Constable and Robinson. The book explains how these fears arise and presents practical steps to deal with them, alongside personal accounts by those affected by paranoid thoughts and includes questionnaires and exercises to help readers learn about and combat their fears.

The frequency of paranoid and suspicious thoughts in the general population

% having thought at least weekly

-- I need to be on my guard against others - 52%
-- Strangers and friends look at me critically - 48%
-- There might be negative comments being circulated about me - 42%
-- People are laughing at me - 34%
-- Bad things are being said about me behind my back - 30%
-- People might be hostile towards me - 29%
-- People deliberately try to irritate me - 27%
-- I might be being observed or followed - 19%
-- People are trying to make me upset - 12%
-- Someone I know has bad intentions towards me - 12%
-- I am under threat from others - 10%
-- I have a suspicion that someone has it in for me - 8%
-- Someone I don't know has bad intentions towards me - 8%
-- People would harm me given the opportunity - 8%
-- There is a possibility of a conspiracy against me - 5%

Examples of paranoid thoughts

Doreen is a fifty-eight year-old shop worker from London: At work, if I am restocking the shelves and other staff members are nearby, I sometimes think they are joking and talking about me, but I know they aren't really.

Chris, a twenty-six year-old teacher: Standing at a bus stop at night when I was back in Liverpool, a group of drunken youths were walking towards me, and I was worried they may be intent on causing trouble, or they may try to hurt me.

Liz, a twenty-four year-old musician from Bristol: I once thought a housemate was trying to steal my possessions as I often caught her standing in the corridor near my room and nowhere near her own room. I got really wound up about this and ended up locking some of my valuables in the garden shed. After this, I began to have other thoughts - like she was trying to poison me because she was always asking me to eat food that she had made and giving me new foreign alcohol to try.

Alex, a forty-two year-old lorry driver and former soldier from Scotland: For a while I used to believe that M15, Mossad, and the police were trying to kidnap and torture me.

Melissa, a thirty-nine year old mother of three, felt that a neighbour was intent upon entering her house and stealing her property.

Greg, a nineteen year-old student: If I'm with a friend and someone rings them on their mobile and they tell the caller they're with me, well if the caller then says something I can't hear and the friend I'm with laughs, I always think that the person on the other end of the phone said something horrible about me.

Richard is a thirty-four year-old journalist. He became fearful that his family was trying to physically harm him.