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Screening for and preventing perinatal depression.

Bonnie D Kerker1, Judy A Greene1, Rachel Gerson1

  • 1New York University School of Medicine, New York, NY.

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Summary

Implementing an on-site depression intervention for pregnant women in NYC public hospitals faced challenges due to lack of funding and staff training. A well-funded, integrated approach is crucial for perinatal depression screening and care effectiveness.

Keywords:
depression screeningdepression treatmentperinatal depressionpostpartum depressionprimary care

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Area of Science:

  • Public Health
  • Mental Health Services Research
  • Implementation Science

Background:

  • New York City public hospitals mandated universal depression screening for pregnant women without allocated funding for screening or treatment.
  • Unfunded mandates often face significant barriers to successful implementation and patient care.

Purpose of the Study:

  • To describe the successes and challenges of implementing an on-site depression prevention intervention (NYC ROSE) for pregnant women in a public hospital setting.
  • To analyze implementation factors using Aarons' implementation model.

Main Methods:

  • Utilized Aarons' implementation model to analyze the NYC ROSE intervention.
  • Reviewed patient tracking sheets, electronic medical records, conducted key informant interviews, focus groups, and staff observations.

Main Results:

  • Lack of funding and staff training (outer context) hindered screening reliability and intervention enrollment.
  • Insufficient early engagement of all staff and patients (inner context) impacted workflow and logistical considerations.
  • A mismatch between the intervention model and patient needs (e.g., transportation, economic priorities) posed challenges.

Conclusions:

  • Effective screening and intervention for perinatal depression require a detailed, thoughtful, and adequately funded approach.
  • Addressing outer and inner contextual factors, alongside patient-specific needs, is vital for successful implementation of mental health services in public hospitals.