Screening for postpartum depression in an inner-city population

This study was undertaken to determine the prevalence of positive screens for postpartum depression by using the Edinburgh Postnatal Depression Scale (EPDS) in an inner-city population.

At their postpartum visits, women who were seen in two inner-city practices between February 20 and April 30, 2002, self-administered the EPDS. A threshold of 10 or more points was selected as a positive screen for postpartum depression. If the patient responded that she had thoughts of harming herself or others, she was referred immediately for social work or psychiatric evaluation. Otherwise, providers were blinded to the results of the screen.

Of the 443 patients who were scheduled for postpartum visits during this time period, 285 (64%) patients presented for their postpartum visit. One hundred twenty-one (42%) of these patients participated in the study and 1 patient did not complete the questionnaire. Twenty-seven (22%) of the 121 patients had a positive screen for postpartum depression. Eight patients (6.6%) reported experiencing suicidal ideation within the previous week. Without use of the screening tool, providers identified 16 (13%) patients who they thought were at risk for postpartum depression. Of those 16 patients, 14 had positive screens on the EPDS. Eight patients eventually had clinical depression diagnosed. There was a significant relationship between women with elevated scores on the EPDS and a personal history of depression (P <.0006), history of prior treatment for depression (P <.0001), and feeling depressed during the pregnancy (P <.0001). Providers failed to comment on the patient's mood in 34 (28%) of the 121 patients.

A larger than expected number of women had a positive screen for postpartum depression in our population. This unexpected finding suggests the need for more resources to be directed toward the research, identification, and treatment of postpartum depression in inner-city populations.