Brief Tools Effectively Diagnose Depression in Young Moms

Diedtra Henderson

December 16, 2013

In bustling primary care pediatric settings, where time and resources are limited, clinicians can use brief screening tools to reliably identify postpartum depression among adolescents, according to a research team that validated the diagnostic tools in 106 young mothers.

Kartik K. Venkatesh, MD, PhD, from the Department of Obstetrics and Gynecology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, and colleagues report the findings of their validation study published online December 16 in Pediatrics.

Some 28% to 59% of pregnant mothers younger than 20 years self-report depressive symptoms, which are significantly higher rates than seen with older pregnant women, according to the authors. The mental ailment derails the young mothers' engagement in health-promoting behaviors for their infants as well as for themselves. What is more, children born to mothers with untreated depression are at higher risk for developmental delay and register lower levels of social engagement.

The researchers screened 106 women from February 2007 to August 2008. Women were eligible if they were younger than 17 years when they conceived and at less than 25 weeks' gestation. Their median age was 16 years; 53% were Latina, 17% were black, and 16% were white. At 6 weeks, 3 months, and 6 months postpartum, women completed formal psychiatric diagnostic interviews, "the gold standard for diagnosis," and the 10-item Edinburgh Postnatal Depression Scale (EPDS). Three EPDS subscales were assessed as brief screening tools.

Nineteen women, or 18%, met the diagnostic criteria for postpartum depression.

Of the trio of abbreviated diagnostic tools, the 7-item depressive symptoms subscale and the 2-item subscale, along with the EPDS, were found to be "highly accurate" in identifying postpartum depression among adolescent mothers. The lengthy EPDS had an overall area under the curve of 0.94. The abbreviated EPDS-7 and ultra-brief EPDS-2 scored overall areas under the curve of 0.96 (95% confidence interval, 0.92 - 0.99) and 0.90 (95% confidence interval, 0.83 - 0.97), respectively.

Although screening mothers for depression has become standard, pediatricians are an underused resource in the prevention battle, the authors note. Because the same clinician would treat young mothers and their offspring, pediatricians are "uniquely situated" to address postpartum depression among teenage mothers, the authors write. Reliance on clinical indicators only uncovers half of the women, however.

"With a wider recognition of the high frequency of postpartum depression among teenage mothers and increasing evidence of the deleterious effects of postpartum depression on maternal and child health, routine screening as part of postpartum care is essential whether in the obstetric provider's office or the pediatrician's office," the authors conclude.

Financial support for the study was provided by the National Institute of Mental Health and the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 16, 2013. Abstract

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