title: A randomized controlled trial of screening for maternal depression with a clinical decision support system.
abstract: OBJECTIVE
  To determine if automated screening and just in time delivery of testing and referral materials at the point of care promotes universal screening referral rates for maternal depression.
  
  
  METHODS
  The Child Health Improvement through Computer Automation (CHICA) system is a decision support and electronic medical record system used in our pediatric clinics. All families of patients up to 15 months of age seen between October 2007 and July 2009 were randomized to one of three groups: (1) screening questions printed on prescreener forms (PSF) completed by mothers in the waiting room with physician alerts for positive screens, (2) everything in (1) plus 'just in time' (JIT) printed materials to aid physicians, and (3) a control group where physicians were simply reminded to screen on printed physician worksheets.
  
  
  RESULTS
  The main outcome of interest was whether physicians suspected a diagnosis of maternal depression and referred a mother for assistance. This occurred significantly more often in both the PSF (2.4%) and JIT groups (2.4%) than in the control group (1.2%) (OR 2.06, 95% CI 1.08 to 3.93). Compared to the control group, more mothers were noted to have depressed mood in the PSF (OR 7.93, 95% CI 4.51 to 13.96) and JIT groups (OR 8.10, 95% CI 4.61 to 14.25). Similarly, compared to the control group, more mothers had signs of anhedonia in the PSF (OR 12.58, 95% CI 5.03 to 31.46) and JIT groups (OR 13.03, 95% CI 5.21 to 32.54).
  
  
  CONCLUSIONS
  Clinical decision support systems like CHICA can improve the screening of maternal depression.
authors: Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA. aaecarro@iupui.edu
authors: Aaron E
authors: AE
authors: Carroll
authors: Paul
authors: P
authors: Biondich
authors: Vibha
authors: V
authors: Anand
authors: Tamara M
authors: TM
authors: Dugan
authors: Stephen M
authors: SM
authors: Downs
mesh_terms: D020000:Decision Support Systems, Clinical; D019052:Depression, Postpartum / Q000517:prevention & control*; D003936:Diagnosis, Computer-Assisted; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010372:Pediatrics; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014481:United States; D014584:User-Computer Interface