Are Family Physicians Appropriately Screening for Postpartum Depression?

Abstract

An estimated 10% to 20% of women develop postpartum depression (PPD) within 6 months after delivery, and the rate may exceed 25% in those having a previous episode. More than half of women with PPD remain symptomatic after 1 year. Because PPD may be underdiagnosed-as many believe to be the case-a cross-sectional questionnaire-based survey concerning screening practices was undertaken in 298 members of the Washington Academy of Family Physicians who regularly saw postpartum women and children less than 12 months of age. Except for the timing, the diagnostic criteria for PPD were identical to those for major depression. Slightly more men than women were questioned. Respondents had an average age of 44 years. Most of the participants worked in group practices. They had been out of residency for 12 years on average. Nearly one third of physicians always screened for PPD, and another 40% often screened women at routine postpartum gynecologic visits. Only approximately 6% of respondents never screened for PPD. Nearly half the physicians screened for PPD at well-child visits. Approximately 30% of physicians who did screen for PPD used a validated screening tool, most often a validated clinical interview. The most popular questionnaire-type screening tool was the Beck Depression Inventory. Most respondents had received some type of formal training in PPD. In general, the physicians regarded PPD as a common, serious, and treatable illness. On multivariate analysis, factors that were significantly associated with more frequent screening included being female, training in PPD during residency, training through medical literature, agreement on the importance of screening for PPD, and rejection of the idea that screening takes too much effort. Training in PPD, using a simple validated screening tool, should be a routine part of the curriculum in all family medicine residency programs. PPD should be presented as a common, readily diagnosed, and treatable disorder.