It is estimated that about 15% of women suffer from depression either during pregnancy or the postpartum period. In 2010, the American College of Obstetricians and Gynecologists (ACOG) recommended screening for depression in all pregnant and postpartum women. Many states have since drafted legislation supporting or mandating universal screening for perinatal depression. What we see now is an increasing number of healthcare professionals who feel comfortable talking about and screening for depression in this population. While many different screening programs have been initiated, we have limited data on the success of these programs. Are women able to access appropriate care? And most importantly, does screening result in improved outcomes?
A small study conducted by Rachel Vanderkruik, PhD and colleagues at the Center for Women’s Mental Health examines what happens to women with probable PPD who are identified using postpartum screening in an obstetric setting. In this study, women were systematically screened at their routine 6-week postpartum obstetric visit using the Edinburgh Postnatal Depression Scale (EPDS). Women with a score of 12 or greater, a score indicative of possible PPD, were eligible to participate and were contacted after 3 months for a follow-up interview and assessment.
Out of the 100 women who scored 12 or greater on the EPDS, a total of 33 women participated in the follow-up visit. Among the participants, 70% reported that they received a referral for the treatment of postpartum depression and nearly one half of the women received treatment (either psychotherapy or medication). At three month, nearly 40% of women continued to score ?12 on the EPDS at the follow-up interview. The two most commonly described barriers to treatment were the perception of not needing or not wanting help and concerns about the use of medications while breastfeeding.
While the current study is small, it indicates that the majority of women with probable PPD receive referral for mental health services. Still, only about half of the women receive treatment, and about 40% of the women continue to be depressed at 3 months postpartum. The authors note that further systematic research on outcomes after PPD screening is needed to ensure that screening translates into meaningfully improved clinical outcomes.
Ruta Nonacs, MD PhD
Vanderkruik R, Freeman MP, Claypoole LD, Arakelian M, Kaimal AJ, Nadel H, Cohen LS. Postpartum depression screening: Treatment engagement, barriers to care, and change in depressive symptoms. Ann Clin Psychiatry. 2021 Nov;33(4):e2-e9.