Abstract
Although screening for perinatal depression substantially improves detection, screening alone does not improve treatment entry or outcome. This paper summarizes a pilot evaluation of the feasibility and patient acceptance of on-site diagnostic assessment in perinatal care settings for women who screen positive for perinatal depressive symptoms. The model included screening, assessment by the perinatal care provider, an algorithm to guide decisions, guidelines for evidence-based antidepressant treatment, support through phone and webbased consultation, and quality monitoring to track and remedy “missed opportunities” for screening and assessment. A mean of 17.1% of women screened were identified as having depressive symptoms in need of further assessment. Of those identified, a mean of 72.0% received a diagnostic assessment on site. A mean of 1.4% of patients refused on-site diagnostic assessment. It is feasible to incorporate assessment for depression into perinatal care. This paves the way for better engagement in treatment, and better clinical outcomes.
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References
Beebe B, Jaffe J, Buck L et al (2008) Six-week postpartum maternal depressive symptoms and 4-month mother-infant self- and interactive contingency. Infant Ment Health J 29:442–471
Birndorf CA, Madden A, Portera L et al (2001) Psychiatric symptoms, functional impairment, and receptivity toward mental health treatment among obstetrical patients. Int J Psychiatry Med 31:355–365
Bruglia TS, Wheatley NA, Taub A et al (2000) Pragmatic randomized trial of antenatal intervention to prevent post-natal depression by reducing psychosocial risk factors. Psychol Med 30:1273–1281
Buist AE, Barnett BE, Milgrom J et al (2002) To screen or not to screen—that is the question in perinatal depression. Med J Aust 7177(Suppl):S101–S105
Callahan CM, Hendrie HC, Dittus RS et al (1994) Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc 42:839–846
Carter FA, Carter JD, Luty SE et al (2005) Screening and treatment for depression during pregnancy: a cautionary note. Aust N Z J Psychiatry 39:255–261
Coates AO, Schaefer CA, Alexander JL (2004) Detection of postpartum depression and anxiety in a large health plan. J Behav Health Serv Res 31:117–133
Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item edinburgh postnatal depression scale. Br J Psychiatry 150:782–786
Davis DA, Taylor-Vaisey A (1997) Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ 157:408–416
Dieter JNI, Emory EK, Johnson KC et al (2008) Maternal depression and anxiety effects on the human fetus: preliminary findings and clinical implications. Infant Ment Health J 29:420–441
Dowrick C, Buchan I (1995) Twelve month outcome of depression in general practice: does detection or disclosure make a difference? BMJ 311(7015):1274–1276
Evins GG, Theofrastous JP, Galvin SL (2000) Postpartum depression: a comparison of screening and routine clinical evaluation. Am J Obstet Gynecol 182:1080–1082
First MB, Spitzer RL, Gibbon M et al (1997) Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version. American Psychiatric, Washington DC
Gaynes BN, Gavin N, Meltzer-Brody S et al (2005) Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Evidence Report/Technology Assessment #119. Agency for Healthcare Research and Quality, Rockville, MD, p 36
Gilbody S, Trevor S, House A (2008) Screening and case-finding instruments for depression: a meta-analysis. CMAJ 178:997–1003
Huot RL, Brennan PA, Stowe ZN et al (2004) Negative affect in offspring of depressed mothers is predicted by infant cortisol levels at 6 months and maternal depression during pregnancy, but not postpartum. Ann N Y Acad Sci. 1032:234–236
Kelly RH, Zatzick DF, Anders TF (2001) The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am J Psychiatry 158:213–219
Li D, Liu L, Odouli R (2009) Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 24:760–761
Lin E, Katon W, Simon G et al (1997) Achieving guidelines for the treatment of depression in primary care: is physician education enough? Med Care 35:831–842
Marcus SM, Flynn HA, Blow FC et al (2003) Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health 12:373–380
Miller LJ, Scremin A, Gupta R (2009) Perinatal depression screening and treatment. In: Handler A, Kennelly J, Peacock N (eds) Women’s Reproductive and Perinatal Health: Interventions and Evidence for Reducing Racial and Ethnic Disparities. Springer: under contract
Murray L, Cooper PJ, Wilson A et al (2003) Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: 2. Impact on the mother-child relationship and child outcome. Br J Psychiatry 182:420–427
Neumeyer-Gromen A, Lampert T, Stark K et al (2004) Disease management programs for depression: a systematic review and meta-analysis of randomized controlled trials. Med Care 42:1211–1221
Pignone MP, Gaynes BN, Rushton JL et al (2002) Screening for depression in adults: a summary of the evidence for the U.S. preventive services task force. Ann Intern Med 136:765–776
Smith MV, Rosenheck RA, Cavaleri MA et al (2004) Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics. Psychiatr Serv 55:407–414
Spitzer RL, Williams JB, Kroenke K et al (2000) Validity and utility of the PRIME=MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients. Am J Obstet Gynecol 183:759–769
Tiemens BG, Ormel J, Jenner JA et al (1999) Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes? Psychol Med 29:833–845
Zlotnick C, Johnson SL, Miller IW et al (2001) Postpartum depression in women receiving public assistance: pilot study of an interpersonal-therapy-oriented group intervention. Am J Psychiatry 158:638–640
Zuckerman B, Bauchner H, Parker S et al (1990) Maternal depressive symptoms during pregnancy, and newborn irritability. J Dev Behav Pediatr 11:190–194
Acknowledgements
This work was supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Maternal and Child Health, Division of Healthy Start and Perinatal Services [P12MC07726: State Grants for Perinatal Depression, FY2004 and FY2006].
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Miller, L., Shade, M. & Vasireddy, V. Beyond screening: assessment of perinatal depression in a perinatal care setting. Arch Womens Ment Health 12, 329–334 (2009). https://doi.org/10.1007/s00737-009-0082-5
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DOI: https://doi.org/10.1007/s00737-009-0082-5