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Detection of postpartum depressive symptoms by screening at well-child visits
Linda H Chaudron1, Peter G Szilagyi, Harriet J Kitzman
1Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA. linda_chaudron@urmc.rochester.edu
Insights
Universal screening for postpartum depression during well-child visits is feasible and effective. Pediatricians can identify mothers with depressive symptoms and increase mental health referrals.
Area of Science:
- Pediatric Health
- Mental Health Screening
- Public Health
Background:
- Postpartum depression affects many mothers.
- Early detection is crucial for maternal and child well-being.
- Pediatric well-child visits offer a unique opportunity for screening.
Purpose of the Study:
- Assess feasibility of universal postpartum depression screening at well-child visits.
- Determine prevalence of depressive symptoms in mothers.
- Evaluate detection rates and social work referrals before and after screening implementation.
Main Methods:
- Implemented universal Edinburgh Postnatal Depression Scale (EPDS) screening.
- Compared medical records from 110 infants before and 110 after screening initiation.
- Analyzed documentation of depressive symptoms and mental health referrals.
Main Results:
- EPDS was included in 46% of visits and completed in 88%.
- 27% of mothers screened had scores indicating depressive symptoms.
- Significant increases in documented depressive symptoms (1.6% to 8.5%) and social work referrals (0.2% to 3.6%) were observed.
Conclusions:
- Universal postpartum depression screening is feasible in pediatric settings.
- Pediatricians can effectively detect postpartum depressive symptoms using standardized tools.
- Well-child visits facilitate early identification and referral for postpartum depression.
Objective:
To assess 1) the feasibility of universal postpartum depression screening during well-child visits in the first year of life, 2) the prevalence of postpartum depressive symptoms among mothers who attend first-year well-child visits, 3) detection of postpartum depressive symptoms in a pediatric clinic before and after universal screening at each first-year well-child visit, and 4) social work referrals before and after universal screening.
Methods:
The practice instituted universal screening for postpartum depressive symptoms during first-year well-child visits using the Edinburgh Postnatal Depression Scale (EPDS). We randomly selected 110 infant medical records before (cohort 1) and 110 after (cohort 2) screening was initiated. Measures included demographics, notation of depression or depressive symptoms in the well-child visit note, and referral for depression. EPDS scores were collected for cohort 2 only. Before-after comparisons were made for detection of depression or depressive symptoms and mental health referrals.
Results:
The EPDS was included in the medical record in 46% of well-child visits. Eighty-eight percent of these forms were completed. Twenty-one percent of completed EPDS forms had scores > or =10, and 27% of women who completed the EPDS had scores > or =10 sometime during the postpartum year. There was a significant increase in documentation of depressive symptoms with the EPDS after initiation of universal screening (1.6% of visits [cohort 1] vs 8.5% [cohort 2]). Social work referrals for mental health reasons increased significantly (0.2% of visits [cohort 1] to 3.6% [cohort 2]).
Conclusions:
Women with high levels of postpartum depressive symptoms are common in an urban population and can be detected at well-child visits throughout the first postpartum year by pediatricians using a standardized screening tool. Because screening for depression during well-child visits is feasible using a standardized screening instrument, pediatricians can play an active role in early detection and referral for postpartum depression.
