25 September 2023, Singapore - KK Women’s and Children’s Hospital (KKH) has introduced universal antenatal depression screening into the routine care programme for pregnant patients. A Singapore first, the Psychological Resilience in Antenatal Management (PRAM) programme is designed to detect depression early in the pregnancy journey, so that the patient can receive the support required for a happy, healthy pregnancy while minimising the risks of perinatal depression.

“We have enhanced the pregnancy journey to include mental health screening as part of holistic routine care for the expectant mother. Under PRAM, screening is conducted during an obstetric check-up in the second trimester, making the process convenient for the patient. More importantly, it allows sufficient time to identify and manage depression issues early, before the baby arrives,” said Dr Chua Tze-Ern, Head and Senior Consultant, Women’s Mental Wellness Service, Department of Psychological Medicine, KKH.

This is part of KKH’s efforts to address the rising incidence of maternal depression, and its impact on the health of the mother and child. Between April 2019 to March 2020 and April 2021 to March 2022, the hospital saw a 47 per cent increase in patients who screened positive for postnatal depression, largely attributed to the COVID-19 pandemic.

In Singapore, one in five pregnant women is affected by antenatal depression. Left untreated, this is a major risk factor for postnatal depression, which can affect mother-child bonding and in the longer term, the child’s neurocognitive development, putting the child at risk for cognitive, behavioural and emotional problems in the future.1, 2, 3

Optimising the continuum of care from pregnancy to childbirth to adulthood
“By extending antenatal depression screening to include every pregnant woman instead of select patients, PRAM strengthens the preventative healthcare framework that supports maternal well-being. Good maternal health provides the best possible chance for an enjoyable pregnancy for the mother, and the best start to life for the fetus, by optimising the child’s future physical, mental and socio-emotional developmental outcomes,” added Dr Chua.

A review of 118 patients who were treated for antenatal depression at the KKH Department of Psychological Medicine over a five-year period found a very good prognostic outcome. Eight in 10 patients, after a few months’ treatment, were discharged from outpatient care in a well and stable state. The prognosis was even better amongst those who had presented for depression for the very first time, with nine in 10 being discharged in a well and stable state.4

“Antenatal depression is highly treatable. Awareness about the impact of mental wellness on maternal health and child development can empower women and their families to make lifestyle adjustments, starting even before pregnancy, to reduce their individual risk factors for perinatal depression, and give their babies the best start to life,” shared Dr Chua.

Under PRAM, screening is conducted using the Edinburgh Postnatal Depression Scale (EPDS) questionnaire, which measures symptoms of depression such as feelings of sadness, anxiety, being overwhelmed, inability to sleep and thoughts of self-harm. Patients with moderate to high risk of antenatal depression will be referred to a clinical counsellor or psychiatrist for individualised care. Less severe cases will be provided educational information as well as counselling support over the phone. The PRAM programme is expected to benefit about 12,000 patients at KKH annually.

1Banozic, A., Cai, S., Chong, S.C., Chong, Y.S., Gluckman, P., Kembhavi-Tam, G., Law, E., Meaney, M., Mildon, R., Mok, A., Seah, C. and Tan, E. (2021), Maternal mental health and well-being during pregnancy linked to brain development and function in children. Evidence Insight, EI001, April.
2Plant, D.T., Barker, E.D., Waters, C.S., Pawlby, S., and Pariante, C.M. (2013). Intergenerational transmission of maltreatment and psychopathology: the role of antenatal depression. Psychological medicine, 43(3), 519-528. https://doi.org/10.1017/S0033291712001298
3Hutchens, B.F. and Kearney, J. (2020). Risk Factors for Postpartum Depression: An Umbrella Review. Journal of Midwifery & Women’s Health, 65:96-108.
4Chua TE, Allen JC, Ang L, Ong LL, Ch’ng YC, Chen H. Patterns and predictors of treatment outcome in antenatal depression. Singapore Medical Journal 2017; 58(11): 642-8