Postpartum depression (PPD) screening has been increasingly implemented not only in obstetric, but also in primary care and pediatric settings, over the past decade. While there is a growing appreciation for the prevalence of PPD and an understanding of the debilitating effects it can have if not treated, few studies have investigated the course of follow-up treatment for women once they screen positive for PPD.
Researchers from the Indiana University School of Medicine invited women who had screened positive for PPD using the Edinburgh Postnatal Depression Scale (EPDS) to participate in a follow-up phone interview. These participants, who were mostly from underserved and lower socioeconomic backgrounds, were recruited from four general pediatric clinics through health records accessed by the Child Health Improvement through Computer Automation (CHICA). CHICA is clinically used to generate screening tools for preventative and ongoing surveillance for various health conditions.
In the 42-item telephone interview, participants were asked specific questions about being screened and subsequent referrals and resources provided, in addition to questions from validated surveys such as the Promoting Healthy Development Survey (PHDS) and the Shared Decision-Making Questionnaire (SDM-Q-9).
73 of the 133 eligible participants agreed to be interviewed and were then included in the final analysis. Of the 73 women, 50 women (68.5%) recalled their child’s pediatrician recommending further treatment, 46 women (63.0%) were provided a handout with community resources, and 36 women (49.3%) indicated that they had “sought treatment.” Of the 36 women, 22 women (30.1%) made an appointment with some type of clinical provider, 10 women made an appointment and also called a community resource from the handout, and 4 women (5.5%) chose to only call a community resource. Overall, only 27 women (37%) attended a scheduled appointment.
The women who decided not to seek treatment had various reasons for not doing so, including their belief that they would not recover from their depressive symptoms, inability to find transportation to an appointment, and lack of time. Some women were also already in treatment.
Importantly, the authors noted that maternal demographics were not significant predictors of whether a mother was recommended treatment or followed through with an appointment. Rather, certain provider behaviors were predictive of a mother receiving follow-up care. For example, mothers who recalled hearing the term “postpartum depression” versus those who did not (56% vs. 18%, p=0.005) and women who reported higher scores of shared decision-making style with their clinician on the SDM-Q-9 were more likely to seek care. When speaking to their patients, providers who explained that the mother needed to make a clear decision about her health (p<0.0001), who mentioned various treatment options for postpartum depression (p=0.004), and who provided the benefits and disadvantages of various treatment options (p=0.01) were more likely to motivate the mother to seek treatment.
This study is the first of its kind to highlight the course of referral and follow-up treatment of postpartum depression after a mother screens positive for PPD. While physicians are increasingly aware of the need to screen postpartum mothers, it is discouraging that only about a third of the women who screened positive for PPD actually attended an appointment with a clinician. Of note, this study indicates that the way in which the information is communicated to the patient is an important factor in motivating them to ultimately seek treatment. Further research is needed to determine what percentage of women who are referred to treatment for PPD are effectively treated and ultimately become euthymic.
Olivia Noe, B.S.
Bauer NS, Ofner S, Pottenger A, Carroll AE and Downs SM (2017). Follow-up of Mothers with Suspected Postpartum Depression from Pediatrics Clinics. Front. Pediatr. 5:212.