Mass General Hospital

Harvard Medical School

Does Universal Screening for Depression in Perinatal Populations Lead to Better Outcomes?

Over the last decade, there has been increased interest around the country in establishing consistent screening for perinatal depression across a range of clinical settings. Approximately 40 states have instituted guidelines and recommendations regarding screening for postpartum depression. These positive developments, in part, follow recommendations from both the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists to move toward routine screening for depression, particularly among vulnerable populations including pregnant and postpartum women.  Given the impact of untreated perinatal mood and anxiety disorders on women and their families, the importance of identifying perinatal depression cannot be overestimated.  However, data describing the outcomes of these screening initiatives have been profoundly lacking.

In the Kaiser Permanente system in Northern California, the Universal Perinatal Depression Screening Program was launched in order to identify women with perinatal depression.  The Patient Health Questionnaire-9 (PHQ-9) to identify women with clinically significant depressive symptoms.  In a recent study, researchers compared rates of screening and subsequent treatment during three phases of program implementation: before implementation, during rollout, and after full implementation. from 2007 through 2014.

The good news is that the implementation of this screening program led to a significant increase in the percentage of pregnant women screened. In the preimplementation phase, less than 1% of the women were screened.  In contrast, after the program was fully implemented, 98% of the women were screened.  
The bad news is that, despite a marked increase in the number of women screened, the percentage of women receiving treatment continued to be fairly low. In the pre-implementatation phase, 60.9% of the women were receiving treatment, compared to 47.1% in the fully implemented program. However, when they looked at women with greater depression severity (with a PHQ of > 15), the percentage of women receiving treatment did increase (5.9% [pre-implementation] to 81.9% [fully implemented]; P<.05).

Universal screening is a good idea, but will it have the desired effects?  At this point, we have very little information on the long term effects of screening. Yes, we can identify women with depression, but does this translate into lower rates of depression and better outcomes in the children later on? We don’t yet know.  

Ruta Nonacs, MD PhD

Lee S. Cohen, MD

 

Improved Perinatal Depression Screening, Treatment, and Outcomes With a Universal Obstetric Program.  Avalos LA, Raine-Bennett T, Chen H, Adams AS, Flanagan T.  Obstet Gynecol. 2016  May; 127(5): 917-25.  Free Article

 

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