Screening for postpartum depression at well-child visits: is once enough during the first 6 months of life?
OBJECTIVE
Screening for maternal depression is gaining acceptance as a standard component of well-child care. We tested the feasibility of this policy and determined the prevalence and incidence of maternal depression at well-child visits during the first 6 months of life.


METHODS
Providers in an adolescent-oriented maternity program were cued electronically, when they opened the electronic medical records of 0- to 6-month-old infants to conduct well-child visits, to ask the mothers to complete the Edinburgh Postpartum Depression Scale. Incident cases represented mothers who crossed the referral threshold (score of > or =10) after the first screening.


RESULTS
Mothers usually brought their infants to the clinic, and none refused screening. Providers could act on 99% of the 418 screening cues; they administered the Edinburgh Postpartum Depression Scale 98% of the time and always referred mothers with scores of > or =10. Overall, 20% of the mothers scored > or =10. Scores were unstable at < or =3 postpartum weeks (kappa = 0.2). Thereafter, the prevalence and incidence of scores of > or =10 decreased from 16.5% at 2 months to 10.3% and 5.7%, respectively, at 4 months. Prevalence increased to 18.5% at the 6-month visit, and incidence decreased to 1.9%. Repeat screening detected only 2 mothers (5.7%) with scores of > or =10.


CONCLUSIONS
Electronic cueing improved compliance with the detection and referral phases of screening for maternal depression at well-child visits. Screening 2 months after delivery detects most mothers who become depressed during the first 6 postpartum months, and screening at the 6-month well-child visit is preferable to screening at the 4-month visit.
Sheeder
Jeanelle
J
Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA. jeanelle.sheeder@ucdenver.edu
Kabir
Karolyn
K
Stafford
Brian
B
D000293:Adolescent; D000367:Age Factors; D003120:Colorado; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods*; D016347:Medical Records Systems, Computerized; D010555:Personality Inventory / Q000706:statistics & numerical data; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care; D011594:Psychometrics; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055815:Young Adult