Pregnancy: Universal Depression Screening Effective, Feasible

Nicola M. Parry, DVM

June 01, 2016

Integration of depression screening into routine prenatal and postpartum obstetric care is not only feasible but can also result in relatively high levels of linkage to evaluation, diagnosis, and treatment of depression for women who screen positive, a new study suggests.

Kartik K. Venkatesh, MD, PhD, from Massachusetts General Hospital and Brigham and Women's Hospital, Boston, and colleagues published the results of their prospective observational cohort study online May 19 in the American Journal of Obstetrics and Gynecology.

"Among nearly 9000 women who were initially screened for depression, 576 (7%) screened positive (i.e. EPDS [Edinburgh Postnatal Depression Scale] ≥12), and close to 80% were linked to mental health services, among whom over three-fourths were diagnosed with major depression and/or an anxiety disorder," the authors write. "Women were significantly more likely to follow up for a mental health evaluation if they screened positive for depression antepartum rather than postpartum."

Depression during pregnancy is common, affecting up to 18% of women, and has been associated with adverse outcomes for both the mother and infant. Yet maternal depression during pregnancy is not always diagnosed and/or treated adequately, despite evidence showing that treatment is beneficial.

The American College of Obstetricians and Gynecologists now recommends that clinicians use a standardized tool to screen women for depression at least once during the perinatal period. In addition, the US Preventive Services Task Force recently published guidelines recommending routine depression screening in women both during pregnancy and postpartum.

However, without interventions after routine screening during pregnancy, fewer than 1 in 5 women who screen positive for depression may be linked to further mental health services by their clinician.

Dr Venkatesh and colleagues therefore aimed to determine the feasibility of large-scale implementation of universal screening for depression in women during both pregnancy and postpartum. They used the EPDS, which is a 10-item questionnaire with psychometric properties that is widely used to evaluate depressive symptoms in pregnant and postpartum women. An EPDS cutoff score of 12 or higher was used as a positive indicator of depression.

The authors analyzed data from July 2010 through June 2014 from 8985 women who were enrolled in prenatal care at a tertiary academic medical center in which a routine depression screening program had been implemented. Of these, 8840 women (98%) were screened antepartum, and 7780 (86%) were screened postpartum. A total of 576 women (7%) screened positive for depression: 396 (69%) screened positive antepartum and 180 (31%) screened positive postpartum (P < .01).

Among women who screened positive for depression, 455 (78.9%) were formally evaluated by a mental health provider, and evaluation occurred more commonly antepartum than postpartum (82.5% vs 71.1%; P < .002); 39% of these women were diagnosed with major depression only, 10% with an anxiety disorder only, and 28% with both major depression and anxiety. Among those who were diagnosed with depression and/or anxiety, 35% received antidepressant medication; this occurred more frequently postpartum than antepartum (54% vs 28%; P < .0001).

Dr Venkatesh and colleagues also found that women were significantly more likely to link to mental health services if they screened positive for depression during pregnancy than postpartum (adjusted odds ratio, 2.09; 95% confidence interval, 1.24 - 3.24; P = .001), after adjusting for patient and demographic factors.

The results of this study suggest that routine depression screening in women, both during pregnancy and postpartum, can lead to high levels of mental healthcare use among women who screen positive.

However, "further data are needed regarding ways to facilitate referral postpartum, as well as long-term mental health follow-up and outcomes following initial psychiatric evaluation after obstetric referral," the authors conclude.

The authors have disclosed no conflicts of interest.

Am J Obstet Gynecol. Published online May 19, 2016. Abstract

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