She Screened Positive for Depression at the First Prenatal Visit, What Really Happens Next?

The aim of this mixed-methods study was to evaluate how providers in a busy urban practice with universal depression screening and co-located behavioral health services responded to positive screens and to explore patient expectations and attitudes towards positive screens. Semi-structured interviews of 20 pregnant women were conducted within 10 days of a positive depression screen or endorsement of suicidal ideation on the Edinburgh Perinatal Depression Scale and health record documentation was reviewed. Qualitative data were entered into a meta-matrix and cross-case analysis was used to reduce the data and determine prominent patterns and themes. Most participants reported discussing their mood with their provider, appreciated the discussion and were satisfied with the plan. Most had documentation of a discussion by their provider. Only 4 of 9 participants who endorsed thoughts of self-harm had documentation of a discussion regarding their response. While nearly all women were recommended for psychotherapy, most did not receive it. Participants expected follow-up but few had discussion of mood documented at the second prenatal visit, independent of seeing the same provider. Co-located behavioral health did not guarantee that services were utilized. There is a need to incorporate tested integrated care approaches to improve assessments and linkage to effective depression treatment.