Twenty years ago, when we started screening for postpartum depression at our hospital, an obstetrics nurse gave the new mother a questionnaire at the mother’s six week visit. If everything went as planned, the mother filled out the form, returned it to tne nurse, who gave it to us. We tallied up the scores, and, if the woman had a score suggestive of depression, we would call her up in order to provide information and resources for women experiencing postpartum depression. Needless to say, the system wasn’t perfect, and our ability to screen all women for postpartum depression was limited.
OK, so that was the dark ages. Now women are given a tablet as they wait for their doctor, they complete some sort of screening for depression, the score is immediately tallied, the doctor is notified, and, in a perfect world, women who have postpartum depression are identified and offered appropriate support and treatment.
But the world is far from perfect when it comes to screening for postpartum depression. What if a woman does not come in for her postpartum visit? As many as 40% of women do not attend a postpartum visit, and the number is even higher among women with limited resources. What if the depression emerges before that first postpartum visit? What if it the mother starts to experience depression after that 6-week postpartum visit, after she no longer is regularly seeing her obstetrician?
Many things can interfere with screening for depression in this population, and it would be unrealistic to expect that one postpartum screening at 4-6 weeks will be able to identify all women with PPD. (The American College of Obstetricians and Gynecologist recommends screening once during pregnancy and again during the postpartum period.) So what strategies can we use to increase engagement and ensure successful screening?
In a recent study researchers tested the feasibility of using text messages to screen for PPD in new mothers. For the first 12 weeks after delivery, 937 women received text messages three times per week containing information about postpartum mental health. Every two weeks, they received a two-question screen for postpartum depression.
A total of 126 women screened positive for postpartum depression. Levels of engagement were high. Overall, 930 of the participants (99%) responded to at least one of the text messages screening for depression, and 632 (78%) responded to all six. After the 12 weeks, 589 participants responded to a satisfaction survey, with most (n = 459) recommending that all women receive screening for postpartum depression via text messaging.
But Then What?
We have seen many studies which have shown successful postpartum depression screening programs in a variety of settings. This is a real success story. However, we still face considerable challenges in ensuring that women who need treatment are able to get it. Too often there are obstacles to treatment: limited numbers of providers with expertise in PPD treatment, inadequate insurance coverage for mental health services, lack of childcare or transportation, to name just a few.
What is appealing about this approach is that it follows the woman out the door and may be a more effective means of retaining a connection with new mothers during pregnancy and the postpartum period. This study did not include a provision for providing treatment itself or resources for treatment; however, one could imagine using text messages in conjunction with other mobile platforms in order to help women with PPD to find support and treatment in their community.
Ruta Nonacs, MD PhD
Lawson A, Dalfen A, Murphy KE, Milligan N, Lancee W. Use of Text Messaging for Postpartum Depression Screening and Information Provision. Psychiatr Serv. 2019 May 1;70(5):389-395.