Beyond screening: assessment of perinatal depression in a perinatal care setting
Although screening for perinatal depression substantially improves detection, screening alone does not improve treatment entry or outcome. This paper summarizes a pilot evaluation of the feasibility and patient acceptance of on-site diagnostic assessment in perinatal care settings for women who screen positive for perinatal depressive symptoms. The model included screening, assessment by the perinatal care provider, an algorithm to guide decisions, guidelines for evidence-based antidepressant treatment, support through phone and webbased consultation, and quality monitoring to track and remedy “missed opportunities” for screening and assessment. A mean of 17.1% of women screened were identified as having depressive symptoms in need of further assessment. Of those identified, a mean of 72.0% received a diagnostic assessment on site. A mean of 1.4% of patients refused on-site diagnostic assessment. It is feasible to incorporate assessment for depression into perinatal care. This paves the way for better engagement in treatment, and better clinical outcomes.
KeywordsPerinatal depression Screening Pregnancy Postpartum
This work was supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Maternal and Child Health, Division of Healthy Start and Perinatal Services [P12MC07726: State Grants for Perinatal Depression, FY2004 and FY2006].
- Buist AE, Barnett BE, Milgrom J et al (2002) To screen or not to screen—that is the question in perinatal depression. Med J Aust 7177(Suppl):S101–S105Google Scholar
- First MB, Spitzer RL, Gibbon M et al (1997) Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version. American Psychiatric, Washington DCGoogle Scholar
- Gaynes BN, Gavin N, Meltzer-Brody S et al (2005) Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Evidence Report/Technology Assessment #119. Agency for Healthcare Research and Quality, Rockville, MD, p 36Google Scholar
- Li D, Liu L, Odouli R (2009) Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 24:760–761Google Scholar
- Miller LJ, Scremin A, Gupta R (2009) Perinatal depression screening and treatment. In: Handler A, Kennelly J, Peacock N (eds) Women’s Reproductive and Perinatal Health: Interventions and Evidence for Reducing Racial and Ethnic Disparities. Springer: under contractGoogle Scholar