Postpartum Depression & Anxiety

PMAD Red Flags & Risk Factors

pmad red flags & risk factors

Guide for Community Partners

Perinatal Mood & Anxiety Disorders (PMAD) are the most common complication of childbirth, affecting 15-20% of pregnant women and women with young children and up to 10% of men with young children.

PMAD Red Flags

Patient is …

  • Having trouble bonding with baby
  • Confused, unable to care for self
  • Suspicious of staff, visitors and family
  • Especially difficult to interact with
  • Experiencing mood instability like excessive anxiety or worry, sadness, irritability
  • Experiencing scary thoughts
  • Responding to internal stimuli
  • Very withdrawn, or shows loss of interest in normal activities

PMAD Risk Factors

  • Personal of family history of PMAD, anxiety, depression, bipolar or any other psychiatric illness
  • Perfectionist personality
  • High expectations of motherhood
  • Recent stressors: illness, divorce, move, job change, death, financial setback
  • Lack of social support
  • Complications with pregnancy or breastfeeding
  • Traumatic labor and delivery
  • Fussy, colicky, ill or high-need baby
  • Reproductive losses: miscarriage, abortion, infertility
  • Unplanned pregnancy
  • Stressful relationship with significant other
  • Mother of multiples
  • Mother of infant(s) in NICU
  • Thyroid imbalance
  • Vitamin D deficiency

Checklist: What To Ask…

During Pregnancy

  • Are you feeling like yourself?
  • How is your sleeping/eating?
  • Do you have the support you need?
  • Are you taking any medications?
  • Have you had times when you feel more worried or sad?
  • Have you ever taken medications for depression/anxiety?
  • Are you taking any vitamins, supplements or herbs?
  • Have you had severe mood changes during your periods?


  • How are you feeling about being a mom?
  • Is there anything more you think I should know about?
  • Do you have any particular concerns?
  • Can you rest when your baby is resting?
  • Can you rest when you want to rest?
  • How is your appetite?
  • Are you feeling like yourself emotionally?
  • Do you have the energy to do the things you need to do?
  • Are you feeling more irritable than usual?
  • Are you having any scary or unusual thoughts?
  • Do you have any thoughts like, “Life isn’t worth living”?
  • Do you ever wish to “fall asleep and not wake up”?


  • Beyond The Blues: Understanding & Treating Prenatal and Postpartum Anxiety, Shoshana Bennett and Pec Indman
  • Dropping the Baby & Other Scary Thoughts, Karen Kleiman
  • Medications and Mother’s Milk 2017, Thomas Hale and Hillary Rowe
  • The Postpartum Husband, Karen Kleiman
  • Therapy & the Postpartum Woman, Karen Kleiman

Referring a Patient

For information on how to refer a patient and more, please visit our Resources for Community Partners page.