The Impact of a Brief Obstetrics Clinic-Based Intervention on Treatment Use for Perinatal Depression

Abstract

The purpose of this study was to examine the association of prenatal depression screening and obstetrics clinician notification procedures with depression treatment use through 6 weeks postpartum. An initial sample of 1298 women was screened for depression as part of routine clinical care at their first prenatal care appointment using the Edinburgh Postnatal Depression Scale (EPDS) at a university hospital obstetrics clinic in the United States. Women with an EPDS > 10 who agreed to participate in this longitudinal study completed assessments of depression and treatment use throughout pregnancy and through 6 weeks postpartum. Following screening and prior to their second prenatal visit, all women scoring > or = 10 on the EPDS received nurse-delivered depression feedback and referral, and all treating physicians were notified of the elevated EPDS status (i.e., > or = 10) of their patients. The majority (65%) of pregnant women with current major depressive disorder (MDD) were not receiving any depression treatment throughout the study period. Overall, women with EDPS > or = 10 who reported that their physician discussed depression with them (67%) were significantly more likely to seek treatment (compared with those who did not report physician discussion of depression with them) by the 1 month prenatal follow-up but not by the 6 weeks postpartum follow-up. Initial depression severity and treatment use prior to screening were the strongest predictors of subsequent depression treatment use. Depression screening combined with systematic clinician follow-up showed a modest short-term impact on depression treatment use for perinatal depression but did not affect depression outcomes. Most women with MDD were not engaged in treatment throughout the follow-up period despite the interventions. More intensive and repeated monitoring might enhance the effect of clinician interventions to improve treatment use.