Patient outcomes following positive depression screening in a postpartum clinic: A single center retrospective cohort...

Depression screening using the Edinburgh Postnatal Depression Scale is commonly performed at the 6-week postpartum visit, yet subsequent referral patterns and clinical outcomes are incompletely characterized.

A single center cohort study was conducted using electronic health records of patients with a completed depression screen at the 6-week postpartum clinic between 2014-2023. Exposure was categorized as screen negative (Edinburgh Postnatal Depression Scale 0-9) or screen positive (Edinburgh Postnatal Depression Scale ≥10) for depressive symptoms. Primary outcome: the proportion of new mental health referrals made (to social work and/or psychiatry services) following the 6-week postpartum depression screen up to 1 year after childbirth. Secondary outcomes: the proportion of patients referred to each specialty after 6 weeks and during the peripartum period (antenatal to 1 year postpartum); patient variables associated with specialty referral from 6 weeks to 1 year postpartum using a multivariable logistic regression model; timing of postpartum referrals after 6-week depression screening; and psychiatric (medications, hospitalizations, mental health diagnoses) and infant associated outcomes within 1 year of childbirth.

Of 41,790 deliveries, 8,155 patients met inclusion criteria. 12.6% received a new mental health referral following 6-week postpartum depression screening up to 1 year after childbirth. After screening, social work and psychiatry referrals occurred in 4.7% and 3.7% of negative-screened patients and 37.1% and 19.5% of positive-screened patients, respectively. Across the peripartum period, social work and psychiatry referrals occurred in 8.6% and 17.5% of negative-screened patients, and 42.0% and 42.5% of positive-screened patients, respectively. Variables associated with referrals (6 weeks to 1 year postpartum) included divorced, separated and widowed marital status, ASA grade ≥3, delivery of a non-viable fetus, neonatal intensive care hospitalization, psychiatric diagnosis, and medication use. Referrals within 2 months postpartum were more frequent following positive screening compared to negative screening; Social Work (84% vs 49%); Psychiatry (53% vs 32%). Psychiatric medications, hospitalizations, mental health diagnoses and infant associated outcomes were more frequent following positive screening.

Positive postpartum depression screening was associated with increased referrals to social work and psychiatry services; however, a critical gap persists between positive screening and specialty referral, diagnosis, and initiation of treatment. Findings support longitudinal mental health screening across the peripartum period.