This
checklist is not intended
to be used to diagnose postpartum depression.
Instead, we hope that it will help you express the way you have been
feeling over the past two weeks.
Some
of the symptoms and feelings will be hard to admit, but we urge you to be
honest, because this will make it easier for you to get the help you and your
baby deserve. Remember that all new
mothers feel this way some of the time.
Such feelings are part of the adjustment to motherhood.
But when mothers feel bad often, or most of the time, we believe that it
is important that you get help from a health professional urgently.
TRY
NOT TO FEEL GUILTY –YOU ARE NOT TO BLAME
AT LEAST ONE IN TEN NEW MOTHERS DO HAVE CLINICAL DEPRESSION AND ANXIETY DURING PREGNANCY AND IN THE FIRST YEAR AFTER THE BIRTH OF A BABY
When
you have completed the checklist, please add up your score, and look at how to
interpret it. Please note the bulleted symptoms and feelings and the comment
about them at the end.
Good luck. Please contact us if you need further information and help.
To complete the Checklist, please fill in the appropriate column - i.e. the one that comes closest to the way you have been feeling and thinking during the past two weeks.
|
0
= NOT AT ALL 1
= FROM TIME TO TIME 2
= QUITE OFTEN 3 = MOST OF THE TIME |
| Symptoms and Feelings |
0 |
1 |
2 |
3 |
| Appetite change | ||||
| Being forgetful | ||||
| Being indecisive | ||||
| Confused thinking | ||||
| Crying spells | ||||
| Fears or fantasies of harming yourself or others | ||||
| Fears or fantasies of harming baby | ||||
| Feeling afraid | ||||
| Feeling angry | ||||
| Feeling anxious | ||||
| Feeling depressed | ||||
| Feeling fatigued | ||||
| Feeling frustrated | ||||
| Feeling guilty | ||||
| Feeling hopeless | ||||
| Feeling irritable | ||||
| Feeling like a bad mother | ||||
| Feeling lonely | ||||
| Feeling no love for the baby | ||||
| Feeling numb | ||||
| Feeling out of control | ||||
| Feeling panicky | ||||
| Feeling that your baby would be better off without you | ||||
| Feeling trapped | ||||
| Feeling unsupported – that no-one cares about you | ||||
| Having scary thoughts | ||||
| Insomnia/changes in your sleep patterns | ||||
| Loss of concentration | ||||
| Loss of interest in your appearance | ||||
| Loss of libido – no interest in sex | ||||
| Loss of motivation | ||||
| Loss of self-esteem | ||||
| Mood swings | ||||
| Obsessive thinking – weird thoughts keep going round in your head | ||||
| Panic attacks | ||||
| Pre-occupation with death –often thinking about death and dying | ||||
| Suicidal thinking – thinking of killing yourself | ||||
| Unusual conflict and fights with people close to you | ||||
| Unusual physical symptoms- headaches, irregular heartbeat, nausea, “knot in your stomach” etc. | ||||
| Unusual weight gain or loss | ||||
| Other | ||||
| SCORE (write total score here) [ ] |
CONTACT A HEALTH PROFESSIONAL IMMEDIATELY IF YOU HAVE ANY OF THE ABOVE SYMPTOMS THAT ARE HIGHLIGHTED IN RED.
| Less than 40 | =MILD adjustment difficulties; |
| 41-69 | =MODERATE-SEVERE Depression and Anxiety |
| 70+ | =SEVERE DEPRESSION AND ANXIETY |
I
AM
If you score above
40, we
recommend that you print this form and take it to your health professional immediately.
Please note: The CHECKLIST is intended to indicate and articulate the most common symptoms and feelings of Depression & Anxiety in pregnancy and during the first year after a baby. It is not an established diagnostic instrument.
©Liz Mills
Post Natal Depression Support Association (
3 Visser Avenue
Trovato Estate
Kenilworth
7708
South Africa
tel: +27 (021) 797 4498