Depression Among Expectant and New Mothers: A Multi-Study Investigation of Rates, Correlates, and Training for Healthcare Providers

Abstract

Perinatal depression (PD) is a common concern among women. PD has been shown to have negative effects on the mother, child, and mother-child relationship. Screening for PD is inconsistent and low among healthcare providers. However, several governing organizations (e.g., The American College of Obstetricians and Gynecologists, The American Academy of Pediatrics) have provided guidelines for screening and treating PD, indicating the importance and utility of screening and treating PD by a variety of healthcare providers. Few studies, with low methodological rigor, have attempted to improve PD screening, treatment, and referral practices. Therefore, it is important to implement and assess additional interventions aimed at improving PD-related knowledge, attitudes, and skills. The overarching purpose of this dissertation was to gain a better understanding of PD rates, correlates, and training for healthcare providers. Study one of this dissertation was a systematic review examining interventions aimed at improving screening and referral for PD for all disciplines of healthcare providers (e.g., students, pediatricians, nurses, obstetricians). Study two of this dissertation assessed PD screening and treatment practices of obstetrical health care providers in one clinic. Study three of this dissertation implemented and assessed an educational intervention for graduate nursing students pertaining to students’ PD screening and treatment. Study one determined that few heterogeneous interventions, with low methodological rigor, exist to improve screening and referral for PD. Most interventions were educational in nature and targeted a range of healthcare providers (e.g., obstetricians, pediatricians, medical students). Study two determined that screening for PD was highest at participants’ 6-week follow up appointment, yet highest rates of clinically significant PD were noted at the intake appointment. Correlates of clinically elevated Edinburgh Postnatal Depression Scale scores at intake and 6-week follow-up appointments were history of depression, history of anxiety, and young age. Study three demonstrated positive gains in PD-related perceived behavioral control, attitudes, subjective norms, knowledge, intention to screen and treat PD, and perceived importance of screening and treating PD from pre- to post-educational intervention.