title: Outcomes from implementing systematic antepartum depression screening in obstetrics.
abstract: This study was developed to evaluate the feasibility of implementing systematic depression screening in a large obstetric practice and to evaluate the degree that detection and referral led to linkage with behavioral healthcare. Depression screening was conducted using the Edinburgh Postnatal Depression Scale, administered at the initial pregnancy care appointment. Patients at or above a predetermined score of 14 were advised to seek further behavioral health assessment through the patient's behavioral healthcare coverage. Within 4 weeks of screening, those referred were contacted by telephone, by clinic staff, to determine whether they had pursued behavioral healthcare as recommended. Limited available data for newly established postdelivery screening were similarly evaluated. All 2,199 newly presenting pregnant women who were seen in our obstetric clinics from September 2008 to May 2009 were screened for depression, and 102 (4.6%) scored at or above an EPDS of 14. Follow-up calls revealed that none had pursued further behavioral health assessments. Of these 2,199, screening and follow-up data were available for 569 women at their 6-week postdelivery visit. Of these, 28 (4.9%) were above EPDS of 14, and 5 (17.9%) reported pursuit of further behavioral healthcare following screening and referral. Peripartum depression can be addressed with systematic screening, and the electronic medical record can readily be used to monitor results. Detection and referral at the beginning of pregnancy did not lead to intended linkage with behavioral healthcare, but detection and referral postdelivery had a modest influence. Barriers to pursuing behavioral healthcare need to be discovered and addressed.
authors.affiliation: Division of Management, Policy, and Community Health, School of Public Health, The University of Texas, Houston, TX 77030, USA. Paul.J.Rowan@uth.tmc.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Rowan
authors.forename: Anthony
authors.initials: A
authors.lastname: Greisinger
authors.forename: Brenda
authors.initials: B
authors.lastname: Brehm
authors.forename: Frances
authors.initials: F
authors.lastname: Smith
authors.forename: Edward
authors.initials: E
authors.lastname: McReynolds
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008605:Mental Health Services / Q000706:statistics & numerical data; D009774:Obstetrics / Q000379:methods; D058725:Peripartum Period / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires