Measures to Identify and Help Women with Ante- and Postnatal Depression

19 Ms Rahayu Mahzam asked the Minister for Health (a) what are the measures put in place in the hospitals to identify and diagnose antenatal and postnatal depression; (b) whether all hospitals are required to screen women for antenatal and postnatal depression; (c) whether there are programmes to educate husbands and extended family members about the symptoms of antenatal and post natal depression; and (d) whether these efforts are part of the National Mental Health Blueprint.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): Most pregnant women are managed by the obstetricians during their pregnancy. They play a major role in identifying antenatal and postnatal depression symptoms, both in the private and public sectors.

KKH and NUH covers 90% of the public sector deliveries. Since 2007, KKH and NUH have been funded under the National Mental Health Blueprint to provide screening and early intervention for postnatal depression. The NUH Women's Emotional Health Service (WEHS) and KKH's Postnatal Depression Intervention Programme (PDIP) provide depression screening at two to eight weeks postpartum, during outpatient postnatal reviews at the specialist clinics. Under the NUH WEHS, women are also screened antenatally at three time points − registration, trimester two and trimester three. Both programmes accept patients referred from other hospitals, including private hospitals. Since 2007, both programmes have screened around 80,050 women; and 818 women were subsequently referred to and seen by psychiatrists for further follow-up.

Women who are screened positive for depression would be managed by a multi-disciplinary team comprising a psychiatrist, case manager and a psychologist. The women and their family members will also be given useful contacts and information on managing their emotional health.

Both programmes also provide antenatal talks and classes open to women and their spouses, covering antenatal and postnatal depression and on keeping emotionally well during and after pregnancy. Through various media platforms, KKH also raises public awareness on postnatal depression.

SGH covers the remaining 10% of public sector deliveries. SGH has a psychiatry clinic located within the obstetric-gynaecology specialist outpatient clinic and obstetricians who pick up women with antenatal and postnatal depression symptoms can refer them to the psychiatry clinic.

Ms Rahayu Mahzam (Jurong): I thank the Senior Minister of State for the answers. Can I just seek clarification? It appears as though the programmes, in respect of the detection of the antenatal and postnatal depression specifically at KKH and NUH, I am wondering whether there will be efforts to encourage these programmes or to develop these programmes in the other hospitals.

My second clarification − can more be done to educate family members about the symptoms of postnatal depression, perhaps by screening of videos at waiting areas, brochures for family members when they attend?

My third clarification – will there be also efforts to educate the general public about antenatal and postnatal depression? I think we have all heard about the recent case where the young mother with a two-month-old daughter took her own life and the State Coroner, Marvin Bee, highlighted that this was a tragic case but it provided us an opportunity to actually look into the effects of postpartum depression, especially with working mothers. So, I was wondering if there are any further effort in this respect.

Dr Amy Khor Lean Suan: With regard to the first question, MOH, in 2010 developed a clinical practice guideline on depression, which is available to all practitioners, both in the private and public hospitals. It includes a section on maternal depression. Clinicians and doctors are encouraged and advised to ask the women specific questions to detect if they perhaps may have antenatal or postnatal depression and then to refer them for appropriate help, say, with a psychiatrist or intervention appropriately.

Besides that, the obstetrician who manages the women during the period of pregnancy are expected to identify symptoms of antenatal or postnatal depression and then to refer them for appropriate intervention, treatment or follow up. And they can also actually refer them to the programmes in KKH and NUH.

In addition to that, HPB, for instance, recently worked with KKH to have a module in the Health Hub Track called Healthy Pregnancy Plan. It also talks about symptoms of antenatal and postnatal depression, signs to look out for, provides information and resources and help that can be provided. Hospitals like KKH also publicise or raise awareness of maternal depression through forums, talks, videos. From the delivery of the baby, HPB has got the Healthy Start for Your Baby Guide which they provide to every mother, both in the private and public hospitals which provide maternal services. It also includes sections on the mother's overall health and well-being and how to look out for postnatal blues, how to mitigate this before it develops into postnatal depression.

Of course, antenatal sessions conducted by the hospitals also include sessions on ante and postnatal depression and these classes can be attended by both the women as well as the spouses. And there are materials available, say, at the waiting areas of hospitals on maternal depression, too.

But I agree with the Member. We need to see how we can continue to strengthen our efforts to engage and reach out to, not just the pregnant women, their spouses and family members but also the public in general, including, of course, employers. In fact, HPB has got a management training workshop for employers to help the HR personnel, for instance, to identify symptoms of depression.

12.30 pm

Mdm Speaker: Order. End of Question Time.

[Pursuant to Standing Order Nos 22(3) and (4), Written Answers to Question Nos 20-22, 24-25, 27, 29-38 and 40-41 on the Order Paper are reproduced in the Appendix. Question Nos 17, 23, 26 and 28 have been postponed to the next available sitting of Parliament and Question No 39 has been withdrawn.]