Automated depression screening in disadvantaged pregnant women in an urban obstetric clinic

A promising means of screening for depression among high-risk perinatal women involves interactive voice response (IVR) technology in which patients self-enter data into a database using a touch tone telephone. Our aim was to test the feasibility of using IVR to screen for depression among low-income, urban pregnant patients and to solicit their preferences for treatment.

The study population included a convenience sample of English-speaking pregnant patients awaiting routine prenatal visits in an urban obstetric clinic. Consenting subjects used a phone in a private clinic room to complete an IVR version of the Edinburgh Postnatal Depression Scale (EPDS). Patients scoring in the "not depressed" range were branched to a closing message while those with mild to severe depressive symptoms were branched to additional automated questions about their treatment preferences.

All 54 participants who consented to the study were able to complete the IVR phone session. More than 90% expressed willingness to complete IVR interviews as part of routine prenatal and postpartum care. Sixteen out of 54 participants (29.6%) scored in the moderate to severe range for depressive symptoms (EPDS >/= 12) which was consistent with a prior study in the same population using a validated paper-pencil screen. Only 12 out of 21 (57%) depressed subjects indicated a desire to speak with a health care provider about how they are feeling. The majority of these depressed subjects preferred to speak with a social worker about housing or financial problems (92%) or an obstetrician or midwife (83%), while a minority (42%) wanted to speak with a mental health professional.

This pilot study suggests that it is feasible to use an automated phone interview to screen for depression in low-income, urban pregnant women.