Mental Health Screening Form - Sydney Babies - Obstetrician Dr. Hugh Porter

It is recommended that all pregnant women in NSW undergo routine mental health screening. The form below is adapted from the “Edinburgh Postnatal Depression Score” which is a validated mental health screening tool. All information provided is confidential in nature. The form takes approximately 5 minutes to fill out. If you have any concerns, or would prefer to do it in person with Dr Porter, please let us know.

Surname *

Weeks Pregnant or Weeks after birth

I have been able to laugh and see the funny side of things: *As much as I always couldNot quite as much nowDefinitely not so much nowNot at all

I have looked forward with enjoyment to things: *As much as I ever didRather less than I used toDefinitely less than I used toHardly at all

I have felt scared or panicky for no very good reason: *Yes, quite a lotYes, sometimesNo, not muchNo, not at all

Things have been getting on top of me: *Yes, most of the time I haven’t been able to cope at allYes, sometimes I haven’t been coping as well as usualNo, most of the time I have coped quite wellNo, I have been coping as well as ever

Do you have any comments or concerns?

Calculation

Presence of some symptoms of distress that may be short-lived and are less likely to interfere with day to day ability to function at home or at work. However if these symptoms have persisted more than a week or two further enquiry is warranted.

Presence of symptoms of distress that may be discomforting. Repeat the EDS in 2 weeks time and continue monitoring progress regularly. If the scores increase to above 12 assess further and consider referral as needed.

Require further assessment and appropriate management as the likelihood of depression is high. Referral to a psychiatrist/psychologist may be necessary.

Requires further evaluation before leaving the office to ensure her own safety and that of her baby.