Postpartum Depressive Symptoms and Screening Opportunities at Health Care Encounters

Area of Science:

• Obstetrics and Gynecology
• Maternal Mental Health
• Public Health

Background:

• The American College of Obstetricians and Gynecologists recommends postpartum depression screening.
• Current screening practices may miss women whose depressive episodes occur outside the standard postpartum checkup.
• Identifying alternative screening opportunities is crucial for comprehensive maternal mental health care.

Purpose of the Study:

• To evaluate women's postpartum healthcare encounters to identify opportunities for screening postpartum depressive symptoms (PDS).
• To assess the utilization of postpartum checkups, well-child visits, and home visitation services among women with and without PDS.
• To determine the potential for these services to serve as screening touchpoints for PDS.

Main Methods:

• Utilized Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012-2015 (n=23,990).
• Assessed PDS using a modified two-item Patient Health Questionnaire.
• Employed Modified Poisson regression to calculate adjusted prevalence ratios (aPR) and confidence intervals (CI) for health service utilization by PDS status.

Main Results:

• High attendance rates for postpartum checkups (85.1% with PDS, 91.4% without) and well-child visits (97.3% with PDS, 98.9% without).
• Home visitation rates were 13.7% for women with PDS and 10.9% for women without PDS (aPR: 1.18; 95% CI: 1.02-1.35).
• Among women with PDS who missed postpartum checkups, 13.5% attended well-child visits and 2.0% received home visitation.

Conclusions:

• Well-child visits and home visitation represent significant opportunities for screening postpartum depressive symptoms (PDS).
• Integrating PDS screening into these alternative postpartum care touchpoints can improve identification and referral.
• Enhanced screening strategies are needed to ensure timely detection and management of PDS in a broader maternal population.