title: Depression screening of perinatal women: an evaluation of the healthy start depression initiative.
abstract: OBJECTIVE
  To address problems with low rates of detection and treatment of depression of pregnant and postpartum women, many advocate depression screening in obstetrical settings. This study evaluated the Healthy Start depression initiative to assess whether it resulted in diminished rates of depressive symptoms and increased rates of detection, referral, and treatment among pregnant and postpartum women.
  
  
  METHODS
  Three cohorts were used to examine the program impact: a pre-Healthy Start depression initiative cohort, a post-Healthy Start depression initiative cohort that was enrolled in New Haven Healthy Start, and a post-Healthy Start depression initiative cohort not enrolled in the New Haven program. Participants included 1,336 pregnant and postpartum women receiving obstetrical care at publicly funded health care clinics. Measures included the Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire; the PTSD Symptom Scale; a five-item modification of the Conflict Tactics Scale; and questions regarding alcohol, illicit substances, and general medical and obstetrical history.
  
  
  RESULTS
  The Healthy Start depression initiative changed neither levels of depressive symptoms nor use of depression treatment in unselected populations. The initiative may have decreased the rate of referral for depression in the cohort under study.
  
  
  CONCLUSIONS
  Universal screening and support for treatment referral by paraprofessionals did not reduce the overall rates of depressive symptoms of perinatal women who received care at publicly funded obstetrical clinics. Future work on depression screening should consider strategies to engage women who are more severely affected by a depressive disorder in behavioral health treatment.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA. kimberly.yonkers@yale.edu
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Yonkers
authors.forename: Megan V
authors.initials: MV
authors.lastname: Smith
authors.forename: Haliqun
authors.initials: H
authors.lastname: Lin
authors.forename: Heather B
authors.initials: HB
authors.lastname: Howell
authors.forename: Lin
authors.initials: L
authors.lastname: Shao
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003237:Connecticut / Q000453:epidemiology; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000706:statistics & numerical data; D011247:Pregnancy / Q000523:psychology*; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult