Abstract
Depression is a frequent accompaniment of the perinatal period. Although screening improves detection of perinatal depression, it does not in itself improve mental health treatment entry and, therefore, does not improve outcomes. This study addresses the feasibility of incorporating diagnostic assessment for depression directly into perinatal care visits and the influence of doing so on entry into mental health treatment. The Perinatal Depression Management Program was implemented in an urban community health center serving a predominantly Hispanic population. The Patient Health Questionnaire (PHQ-9) was administered during perinatal visits. Positive screens (scores ≥10) were followed within the same visit by brief diagnostic assessment and engagement strategies. Chart review was conducted to compare rates of screening, assessment, and treatment entry during a 3-month baseline period before implementation of the intervention (n=141) with a 1-year period after implementation of the intervention (n=400). Before the intervention, 65.2% of patients completed a PHQ-9, and 10% of patients with positive screens received on-site assessment. None of the patients with identified perinatal depression entered treatment. After model implementation, significantly more (93.5%) completed a PHQ-9, and of patients with positive screens, 84.8% received an on-site assessment. Among patients diagnosed with major depression and offered treatment, 90% entered treatment. It is feasible to implement diagnostic assessment for depression within perinatal clinic visits. Doing so may substantially increase entry into mental health treatment for women with perinatal major depression while reducing unnecessary mental health referral of patients with false positive screens.
Highlights
Depression is one of the most frequent accompaniments of the perinatal period, with an estimated period prevalence of 9.4%–12.7% during pregnancy and up to 21.9% during the first year postpartum.[1]
The current study focuses on treatment entry rather than treatment outcomes but is part of a larger project, the Perinatal Depression Management Program (PDMP), that includes a specific integrated treatment model and is designed to study outcomes
On-site assessment by perinatal clinicians was documented in 84.8% of women who screened positive
Summary
Depression is one of the most frequent accompaniments of the perinatal period, with an estimated period prevalence of 9.4%–12.7% during pregnancy and up to 21.9% during the first year postpartum.[1]. Screening improves detection of perinatal depression, it does not in itself improve mental health treatment entry and, does not improve outcomes. This study addresses the feasibility of incorporating diagnostic assessment for depression directly into perinatal care visits and the influence of doing so on entry into mental health treatment. The Patient Health Questionnaire (PHQ-9) was administered during perinatal visits. None of the patients with identified perinatal depression entered treatment. Significantly more (93.5%) completed a PHQ-9, and of patients with positive screens, 84.8% received an on-site assessment. Conclusions: It is feasible to implement diagnostic assessment for depression within perinatal clinic visits. Doing so may substantially increase entry into mental health treatment for women with perinatal major depression while reducing unnecessary mental health referral of patients with false positive screens
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