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Community Mental Health Journal

, Volume 50, Issue 3, pp 305–311 | Cite as

Online Screening and Referral for Postpartum Depression: An Exploratory Study

  • Emily DrakeEmail author
  • Erica Howard
  • Emily Kinsey
Original Paper

Abstract

The fear and stigma associated with postpartum depression (PPD) is a major challenge in the treatment of this disease. Our goal is to develop innovative methods of screening women for the symptoms of PPD to facilitate referral and treatment. This study explores the efficacy of the Internet in reaching out to postpartum women in the convenience and privacy of their own homes, particularly those in rural and underserved areas. An exploratory study design was used to explore the feasibility and acceptability of online screening for PPD with postpartum women in the first 2–3 months after delivery (N = 18). In the first phase, a focus group was conducted with a small group of postpartum women; the second phase consisted of individual interviews of postpartum women in their homes; and in phase three, 10 women participated in the on-line screening intervention. PPD was measured using an online version of the Edinburgh Postnatal Depression Scale (EPDS) a well-established instrument with reported alpha reliabilities (0.81–0.88) across studies and concurrent validity demonstrated using the gold standard, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for depression interview. Qualitative data collected from all the participants were also analyzed. The sample included women age 18–29; 70 % White/Caucasian, 50 % low income, and the majority living in rural areas. The EPDS scores ranged from 0 to 13 (mean 8.0; SD 4.76). Participants described the online PPD screening process as easy, straightforward and personalized and provided additional suggestions for improvement.

Keywords

Postpartum depression Internet Screening Referral 

Notes

Acknowledgments

NIH-NINR grant P20NR009009, Rural Health Care Research Center, University of Virginia School of Nursing, Postpartum Support International (PSI), Susan Hickman Research Award.

References

  1. Amankwaa, L. (2003). Postpartum depression among African-American women. Issues in Mental Health Nursing, 24, 297–316. doi: 10.1080/01612840390160801.PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association. (2000). Diagnostic criteria from DSM-IV-TR. Washington, D.C.: The Association.Google Scholar
  3. Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry, 40(1), 51–54.PubMedCrossRefGoogle Scholar
  4. Beeghly, M., Weinberg, M. K., Olson, K. L., Kernan, H., Riley, J., & Tronick, E. Z. (2002). Stability and change in level of maternal depressive symptomatology during the first postpartum year. Journal of Affective Disorders, 71(1–3), 169–180. doi: 10.1016/S0165-0327(01)00409-8.PubMedCrossRefGoogle Scholar
  5. Buchanan, T. (2002). Online assessment: Desirable or dangerous? Professional Psychology-Research and Practice, 33(2), 148–154. doi: 10.1037//0735-7028.33.2.148.CrossRefGoogle Scholar
  6. Chaudron, L. H., Szilagyi, P. G., Tang, W., Anson, E., Talbot, N. L., Wadkins, H. I., et al. (2010). Accuracy of depression screening tools for identifying postpartum depression among urban mothers. Pediatrics, 125(3), e609–e617.PubMedCentralPubMedCrossRefGoogle Scholar
  7. Cox, J. L., & Holden, J. M. (2007). Perinatal mental health: A guide to the Edinburgh Postnatal Depression Scale. Glasgow: Royal College of Psychiatrists.Google Scholar
  8. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.PubMedCrossRefGoogle Scholar
  9. Dennis, C. L. (2004). Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale? Journal of Affective Disorders, 78(2), 163–169.PubMedCrossRefGoogle Scholar
  10. Dillman, D., Smyth, J., & Christian, M. (2009). Internet, mail, and mixed-mode surveys: The tailored design method (3rd ed.). Hoboken, NJ: Wiley.Google Scholar
  11. Drake, E., & Coolidge, G. (2010). Postpartum depression: Don’t let patients suffer in silence. American Nurse Today, 5(12), 1–5.Google Scholar
  12. Earls, M. F., & Committee on Psychosocial Aspects of Child and Family Health American Academy of Pediatrics. (2010). Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics, 126(5), 1032–1039.PubMedCrossRefGoogle Scholar
  13. Edwards, E., & Timmons, S. (2005). A qualitative study of stigma among women suffering postnatal illness. Journal of Mental Health, 14(5), 471–481. doi: 10.1080/09638230500271097.CrossRefGoogle Scholar
  14. England, M., & Sim, L. (2009). Depression in parents, parenting, and children: Opportunities to improve identification, treatment, and prevention. The National Academies Press. Retrieved from http://www.nap.edu/catalog.php?record_id=12565.
  15. Ensminger, M., Hanson, S., Riley, A., & Juon, H. (2003). Maternal psychological distress: Adult sons’ and daughters’ mental health and educational attainment. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1108–1115.PubMedCrossRefGoogle Scholar
  16. Estes, L. J., Lloyd, L. E., Teti, M., Raja, S., Bowleg, L., Allgood, K. L., et al. (2010). Perceptions of audio computer-assisted self-interviewing (ACASI) among women in an HIV-positive prevention program. PLoS ONE [Electronic Resource], 5(2), e9149.CrossRefGoogle Scholar
  17. Flynn, H., Henshaw, E., O’Mahen, H., & Forman, J. (2009). Patient perspectives on improving the depression referral processes in obstetrics settings: A qualitative study. General Hospital Psychiatry, 32, 9–16. doi: 10.1016/genhosppsyc.2009.07.005.PubMedCentralPubMedCrossRefGoogle Scholar
  18. Gaynes, B., Gavin, N., Melzer-Brody, S., Lohr, K., Swinson, T., Gartlehner, G., et al. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  19. Golberstein, E., Eisenberg, D., & Gollust, S. E. (2008). Perceived stigma and mental health care seeking. Psychiatric Services, 59(4), 392–399.PubMedCrossRefGoogle Scholar
  20. Goodman, J., & Tyer-Viola, L. (2010). Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. Journal of Women’s Health, 19(3), 477–490. doi: 10.1089/jwh.2008.1352.PubMedCrossRefGoogle Scholar
  21. Grace, S., Evindar, A., & Stewart, D. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Women’s Mental Health, 6(4), 263–274.PubMedCrossRefGoogle Scholar
  22. Houston, T., Cooper, L., Vu, H., Kahn, J., Toser, J., & Ford, D. (2001). Screening the public for depression through the internet. Psychiatric Services, 52(3), 362–367.PubMedCrossRefGoogle Scholar
  23. Kim, J. J., La Porte, L. M., Adams, M. G., Gordon, T. E., Kuendig, J. M., & Silver, R. K. (2009). Obstetric care provider engagement in a perinatal depression screening program. Archives of Women’s Mental Health, 12(3), 167–172.PubMedCrossRefGoogle Scholar
  24. Le, H., Perry, D., & Sheng, X. (2009). Using the internet to screen for postpartum depression. Maternal and Child Health Journal, 13, 213–221. doi: 10.1007/s10995-008-0322-8.PubMedCrossRefGoogle Scholar
  25. Lees, S. (2009). Professionals’ knowledge of perinatal mental health care. Mental Health Practice, 13(4), 24–27.CrossRefGoogle Scholar
  26. Logsdon, M. C., & Myers, J. A. (2010). Comparative performance of two depression screening instruments in adolescent mothers. Journal of Women’s Health, 19(6), 1123–1128. doi: 10.1089/jwh.2009.1511.PubMedCrossRefGoogle Scholar
  27. Logsdon, M. C., Wisner, K., Hanusa, B. H., & Phillips, A. (2003). Role functioning and symptom remission in women with postpartum depression after antidepressant treatment. Archives of Psychiatric Nursing, 17(6), 276–283. doi: 10.1053/j.apnu.2003.10.004.PubMedCrossRefGoogle Scholar
  28. Marcus, S. M. (2009). Depression during pregnancy: Rates, risks and consequences—Motherisk update 2008. Canadian Journal of Clinical Pharmacology/Journal Canadien De Pharmacologie Clinique, 16(1), e15–e22.Google Scholar
  29. McGarry, J., Kim, H., Sheng, X., Egger, M., & Baksh, L. (2009). Postpartum depression and help-seeking behavior. Journal of Midwifery & Women’s Health, 54(1), 50–56. doi: 10.1016/j.jmwh.2008.07.003.CrossRefGoogle Scholar
  30. Nazareth, I. (2011). Should men be screened and treated for postnatal depression? Expert Review of Neurotherapeutics, 11(1), 1–3.PubMedCrossRefGoogle Scholar
  31. Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA, 303(19), 1961–1969.PubMedCrossRefGoogle Scholar
  32. Reichenheim, M. E., Moraes, C. L., Oliveira, A. S., & Lobato, G. (2011). Revisiting the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS): Empirical evidence for a general factor. BMC Medical Research Methodology, 11, 93.PubMedCentralPubMedCrossRefGoogle Scholar
  33. Russell, S. (2006). Barriers to care in postnatal depression. Community Practitioner, 79(4), 110–111.PubMedGoogle Scholar
  34. Seehusen, D., Baldwin, L., Runkle, G., & Clark, G. (2005). Are family physicians appropriately screening for postpartum depression? Journal of the American Board of Family Medicine, 18(2), 104–112.CrossRefGoogle Scholar
  35. Skårderud, F. (2003). Sh@me in cyberspace. Relationships without faces: The E-media and eating disorders. European Eating Disorders Review, 11(3), 155–169. doi: 10.1002/erv.523.CrossRefGoogle Scholar
  36. Sword, W., Busser, D., Ganann, R., McMillan, T., & Swinton, M. (2008). Women’s care-seeking experiences after referral for postpartum depression. Qualitative Health Research, 18(9), 1161–1173.PubMedCrossRefGoogle Scholar
  37. Tate, D., & Zabinsky, M. (2004). Computer and internet applications for psychological treatment: Update for clinicians. Journal of Clinical Psychology, 33(2), 209–220. doi: 10.1002/jclp.10247.CrossRefGoogle Scholar
  38. Ugarriza, D. (2004). Group therapy and its barriers for women suffering from post-natal depression. Archives of Psychiatric Nursing, 18(2), 39–48. doi: 10.1053/j.apnu.2004.01.002.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.University of Virginia School of NursingCharlottesvilleUSA
  2. 2.University of Virginia School of MedicineCharlottesvilleUSA

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