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# Perinatal mental health: screening, baby blues, depression and psychosis, and when to call

- Assessment

About 1 in 5 women has a mental health problem in pregnancy or the year after birth. The nurse asks at every contact and knows which signs are an emergency.

Updated Nov 13, 2026

## Key points

- Baby blues: tearfulness, anxiety and irritability in the first week or two; they go away without treatment (MedlinePlus).
- Postpartum depression can start up to a year after birth, most often in the first 3 months.
- Res. 3280: two questions at each contact (feeling sad or hopeless, and losing interest or pleasure, in the last month). Two «yes» answers → psychology and psychiatry.
- EPDS: a self-report scale; Res. 3280 asks for mental health follow-up after discharge when the score is above 12.
- Postpartum psychosis (1 to 2 per 1,000 births, usually in the first 2 weeks) is a psychiatric emergency.

On this page

- The basics Key points
- What it is
- Reference values
- What you need
- How to measure it (and why)
- Baby blues, depression and psychosis after birth (own summary from MedlinePlus and PMC)
- How to read it
- Next step: when to call for help
- Elsewhere in DurgiPedia

- Study Test yourself

- Connections Connections

## What it is

WHO estimates that almost 1 in 5 women has a mental health condition during pregnancy or in the year after birth, and that one in five of them has suicidal thoughts or self-harm. Res. 3280 de 2018 asks staff to screen for postpartum depression at each contact with two short questions, and to follow up through mental health any woman with a score above 12 on the Edinburgh Postnatal Depression Scale (EPDS). The nurse asks in a respectful, private setting, tells baby blues from depression, and treats suspected psychosis or thoughts of harming herself or the baby as an emergency. Treatment is decided by the doctor and the mental health team.

## Reference values

- The EPDS (Edinburgh Postnatal Depression Scale) asks the woman about her mood and anxiety; its items are not reproduced here and it is applied as the protocol says.
- Risk factors (MedlinePlus): previous depression, bipolar disorder or anxiety; a difficult birth or an ill or preterm baby; little support; relationship, money or housing problems; substance use; mixed feelings about the pregnancy.
- Psychosis: early irritability, mood swings and insomnia, then mania, depression or mixed states, often with delusions and confusion; more than half have no previous psychiatric history.
- Bipolar disorder is the diagnosis most often found in women with postpartum psychosis.

## What you need

- A private, quiet and respectful space.
- The two questions of Res. 3280 and the EPDS form used by the institution.
- The referral route to psychology, psychiatry and the emergency service.
- Time to listen.

## How to measure it (and why)

- Ask in private and without judgement; explain that these feelings are common and treatable — a stigma-free setting helps her answer honestly.
- Ask the two questions of Res. 3280 at each postpartum contact — two «yes» answers need confirmation by psychology or psychiatry.
- Apply the EPDS when the protocol says and record the score — above 12, Res. 3280 asks for mental health follow-up.
- Always ask directly about thoughts of harming herself or the baby — MedlinePlus says they must be reported right away.
- Watch sleep, self-care, confusion, odd ideas and how she relates to the baby — psychosis may show before she can tell you.
- Review risk factors and her support network — little support raises the risk.
- Explain the difference between baby blues and depression, and tell the family which signs need help — the family often notices first.
- If you suspect psychosis or thoughts of harm to herself or the baby, stay with her, call the doctor at once, follow the protocol — both are emergencies.

## Baby blues, depression and psychosis after birth (own summary from MedlinePlus and PMC)

| Condition | When | What it looks like | What to do |
| --- | --- | --- | --- |
| Baby blues | First 1 to 2 weeks | Tearful, anxious, irritable, restless; she can still care for herself and the baby | Support and information; review if it lasts beyond 2 weeks |
| Postpartum depression | Up to a year, mostly in the first 3 months | Low mood, loss of interest, guilt, poor sleep or appetite, difficulty caring for the baby | Referral to psychology and psychiatry; follow up |
| Postpartum psychosis | Usually first 2 weeks | Confusion, rapid mood changes, delusions, little insight | Emergency: stay with her and call at once |

## How to read it

- Depression is diagnosed by the clinician from the symptoms; the screening questions only find who needs that assessment.
- Thyroid disease, anaemia, infection and eclampsia can mimic or trigger psychiatric symptoms, so the medical team examines her too.
- Ask about violence as the protocol says; partner-violence screening is covered on the gender-violence page.
- WHO: one in five women with a perinatal mental health condition has suicidal thoughts or self-harms.

## Next step: when to call for help

- Emergency, call at once: thoughts of harming herself or the baby, a suicide attempt, confusion, hearing or seeing things others do not, or beliefs not based in reality.
- Refer the same day: two «yes» answers to the screening questions, or she cannot care for herself or the baby.
- Refer for mental health follow-up: an EPDS score above 12 (Res. 3280).
- Review: baby blues lasting more than 2 weeks or getting worse.

## Test yourself

Think of the answer, then tap the question to see it.

## How long do baby blues usually last?

The first week or two after birth; they go away without treatment.

## What does Res. 3280 ask when a woman answers yes to both screening questions?

Assessment by psychology and psychiatry to confirm depression and give the support she needs.

## Above which EPDS score does Res. 3280 ask for mental health follow-up after discharge?

Above 12 points.

## When does postpartum psychosis usually start, and how is it treated by the nurse?

Usually in the first 2 weeks; as a psychiatric emergency: stay with her and call at once.

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## Elsewhere in DurgiPedia

- [Screening questionnaires in primary care](https://durgical.com/en/behavioral-science/screening-questionnaires-in-primary-care/)

## Connections

## Related 2

- [The postpartum assessment: uterus, lochia, perineum, breasts, bladder, legs, mood and bonding](https://durgical.com/en/nursing/the-postpartum-assessment-uterus-lochia-perineum-breasts-bladder-legs-mood-and-b/)
- [Therapeutic communication: techniques and barriers](https://durgical.com/en/nursing/therapeutic-communication-techniques-and-barriers/)

## Related conditions 2

- [Perinatal depression and postpartum psychosis](https://durgical.com/en/conditions/perinatal-depression-and-postpartum-psychosis/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-3280-de-2018.pdf) (Ministerio de Salud y Protección Social de Colombia, 2018); [Launch of the WHO guide for integration of perinatal mental health in maternal and child health services](https://www.who.int/news/item/19-09-2022-launch-of-the-who-guide-for-integration-of-perinatal-mental-health) (World Health Organization, 2022); [Postpartum depression](https://medlineplus.gov/ency/article/007215.htm) (MedlinePlus, U.S. National Library of Medicine, 2025); [Management of new onset psychosis in the postpartum period (J Clin Psychiatry, 2017)](https://pmc.ncbi.nlm.nih.gov/articles/PMC5773376/) (PubMed Central, 2017).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/perinatal-mental-health-screening-baby-blues-depression-and-psychosis-and-when-t/