Journal of Child and Family Studies

, Volume 27, Issue 10, pp 3169–3175 | Cite as

Screening for and Preventing Perinatal Depression

  • Bonnie D. KerkerEmail author
  • Judy A. Greene
  • Rachel Gerson
  • Michele Pollock
  • Kimberly E. Hoagwood
  • Sarah McCue Horwitz
Original Paper


New York City (NYC) public hospitals recently mandated that all pregnant women be screened for depression, but no funds were allocated for screening or care coordination/treatment, and research suggests that unfunded mandates are not likely to be successful. To address this, we implemented an on-site depression prevention intervention (NYC ROSE) for positive depression screens among pregnant, mostly Black and Hispanic, lower-income women in one public hospital. In this paper, we used Aarons’ implementation model to describe the successes and challenges of screening and intervention. Patient tracking sheets and electronic medical records were abstracted. Key informant interviews and an informal focus group were conducted, and staff observations were reviewed; common implementation themes were identified and fit into Aarons’ model. We found that a lack of funding and staff training, which led to minimal psychoeducation for patients, were outer context factors that may have made depression screening difficult, screening results unreliable, and NYC ROSE enrollment challenging. Although leadership agreed to implement NYC ROSE, early involvement of all levels of staff and patients would have better informed important inner context factors, like workflow and logistical/practical challenges. There was also a mismatch between the treatment model and the population being served; patients often lived too far away to receive additional services on site, and economic issues were often a higher priority than mental health services. Screening and interventions for perinatal depression are essential for optimal family health, and a detailed, thoughtful and funded approach can help ensure effectiveness of such efforts.


Postpartum depression Perinatal depression Primary care Depression treatment Depression screening 



We would like to acknowledge and thank Caron Zlotnick, Lauren Kincal Veznedaroglu, Priscilla Shorter, Betzabet Giron, Anya Urcuyo, Hannah Ephraim, Michele Knobel, Omobolanle Oladokun, Kelly Fitzgerald and Ming Tsai for their contributions to this study.

Author Contributions

B.D.K.: designed and executed the study and wrote the paper. J.A.G.: designed and executed the study and contributed to the writing of the paper. R.G.: collaborated with the design and execution of the study, and contributed to the writing of the paper. M.P.: collaborated with the design and execution of the study, and contributed to the writing of the paper. K.E.H.: collaborated with the design and execution of the study, and contributed to the writing of the paper. S.M.H.: designed the study, collaborated with the execution of the study, and contributed to the writing of the paper.


This study was funded by the National Institutes of Mental Health P30MH090322.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. Aarons, G. A., Hurlburt, M, & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23.CrossRefGoogle Scholar
  2. Biggar, H. (2001). Homeless children and education: An evaluation of the Stewart B. McKinney Homeless Assistance Act. Children and Youth Services Review, 23, 941–969.CrossRefGoogle Scholar
  3. Bologna, C. (2015). The important thing hospitals have pledged to do for new moms.
  4. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.CrossRefGoogle Scholar
  5. Byatt, N., Levin, L. L., Ziedonis, D., Simas, T. A. M., & Allison, J. (2015). Enhancing participation in depression care in outpatient perinatal care settings: a systematic review. Obstetrics & Gynecology, 126, 1048–1058.CrossRefGoogle Scholar
  6. Canvin, K., Jones, C., Marttila, A., Burström, B., & Whitehead, M. (2007). Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: qualitative study. Journal of Epidemiology and Community Health, 61, 984–989.CrossRefGoogle Scholar
  7. Chaudron, L. H., Szilagyi, P. G., Kitzman, H. J., Wadkins, H. I., & Conwell, Y. (2004). Detection of postpartum depressive symptoms by screening at well-child visits. Pediatrics, 113, 551–558.CrossRefGoogle Scholar
  8. Committee on Obstetric Practice. (2015). Screening for perinatal depression. Committee Opinion No. 630. American College of Obstetricians and Gynecologists. Obstetrics & Gynecology, 125, 1268–71.Google Scholar
  9. Derr, A. S. (2015). Mental health service use among immigrants in the United States: A systematic review. Psychiatric Services, 67, 265–274.CrossRefGoogle Scholar
  10. Earls, M. F. (2010). Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics, 126, 1032–1039.CrossRefGoogle Scholar
  11. Evins, G. G., Theofrastous, J. P., & Galvin, S. L. (2000). Postpartum depression: A comparison of screening and routine clinical evaluation. American Journal of Obstetrics and Gynecology, 182, 1080–1082.CrossRefGoogle Scholar
  12. Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33(1), 1–6.CrossRefGoogle Scholar
  13. Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2011). Treatment of postpartum depression: Clinical, psychological and pharmacological options. International Journal of Women’s Health, 3, 1–14.Google Scholar
  14. Fixsen, D., Blasé, K., Naoom, S., & Wallace, F. (2009). Core implementation components. Research Ion Social Work Practice, 19, 531.CrossRefGoogle Scholar
  15. Flanagan, T., & Avalos, L. A. (2016). Perinatal obstetric office depression screening and treatment: Implementation in a health care system. Obstetrics & Gynecology, 127, 911–915.CrossRefGoogle Scholar
  16. Goodman, J. H., & 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.CrossRefGoogle Scholar
  17. Goyal, D., Gay, C., & Lee, K. (2010). How much does low socioeconomic status increase the risk of prenatal and postnatal depressive symptoms in first-time mothers? Women’s Health Issues, 20(2), 96–104.CrossRefGoogle Scholar
  18. Kneipp, S. M., Kairalla, J. A., Stacciarini, J. M. R., Pereira, D., & Miller, M. D. (2010). Comparison of depressive symptom severity scores in low-income women. Nursing Research, 59, 380.CrossRefGoogle Scholar
  19. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle Scholar
  20. Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services, 62, 619–625.CrossRefGoogle Scholar
  21. Lorant, V., Croux, C., Weich, S., Deliege, D., Mackenbach, J., & Ansseau, M. (2007). Depression and socio-economic risk factors: 7-year longitudinal population study. The British Journal of Psychiatry, 190, 293–298.CrossRefGoogle Scholar
  22. Marcus, S. M., Flynn, H. A., Blow, F. C., & Barry, K. L. (2003). Depressive symptoms among pregnant women screened in obstetric settings. Journal of Women’s Health, 12, 373–380.CrossRefGoogle Scholar
  23. Miller, L., Shade, M., & Vasireddy, V. (2009). Beyond screening: Assessment of perinatal depression in a perinatal care setting. Archives of Women’s Mental Health, 12, 329.CrossRefGoogle Scholar
  24. Misri, S., & Kendrick, K. (2007). Treatment of perinatal mood and anxiety disorders: A review. The Canadian Journal of Psychiatry, 52, 489–498.CrossRefGoogle Scholar
  25. Murray, L., Arteche, A., Fearon, P., Halligan, S., Croudace, T., & Cooper, P. (2010). The effects of maternal postnatal depression and child sex on academic performance at age 16 years: a developmental approach. Journal of Child Psychology and Psychiatry, 51, 1150–1159.CrossRefGoogle Scholar
  26. Nadeem, E., Lange, J. M., Edge, D., Fongwa, M., Belin, T., & Miranda, J. (2007). Does stigma keep poor young immigrant and US-born black and Latina women from seeking mental health care? Psychiatric Services, 58, 1547–1554.CrossRefGoogle Scholar
  27. Palinkas, L. A., Schoenwald, S. K., Hoagwood, K., Landsverk, J., Chorpita, B. F., & Weisz, J. R. (2008). An ethnographic study of implementation of evidence-based treatments in child mental health: First steps. Psychiatric Services, 59, 738–746.CrossRefGoogle Scholar
  28. Schulberg, H. C., Coulehan, J. L., Block, M. R., Lave, J., Rodriguez, W., Scott, C. P. …, & Perel, J. (1993). Clinical trials of primary care treatments for major depression: Issues in design, recruitment and treatment. The International Journal of Psychiatry in Medicine, 23(1), 29–42.CrossRefGoogle Scholar
  29. Sidebottom, A. C., Harrison, P. A., Godecker, A., & Kim, H. (2012). Validation of the Patient Health Questionnaire (PHQ)-9 for prenatal depression screening. Archives of Women’s Mental Health, 15, 267–374.CrossRefGoogle Scholar
  30. Sui, A. L., the U.S. Preventive Services Task Force (USPSTF). (2016). Screening for depression in adults: US Preventive Services Task Force Recommendation Statement. Journal of the American Medical Association, 315, 380–7.Google Scholar
  31. Yoo, J., Brooks, D., & Patti, R. (2007). Organizational constructs as predictors of effectiveness in child welfare interventions. Child Welfare, 86(1), 53–78.Google Scholar
  32. Zlotnick, C., Johnson, S. L., Miller, I. W., Pearlstein, T., & Howard, M. (2001). Postpartum depression in women receiving public assistance: Pilot study of an interpersonal-therapy-oriented group intervention. American Journal of Psychiatry, 158, 638–640.CrossRefGoogle Scholar
  33. Zlotnick, C., Miller, I. W., Pearlstein, T., Howard, M., & Sweeney, P. (2006). A preventive intervention for pregnant women on public assistance at risk for postpartum depression. American Journal of Psychiatry, 163, 1443–1445.CrossRefGoogle Scholar
  34. Zlotnick, C., Tzilos, G., Miller, I., Seifer, R., & Stout, R. (2016). Randomized controlled trial to prevent postpartum depression in mothers on public assistance. Journal of Affective Disorders, 189, 263–268.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Bonnie D. Kerker
    • 1
    Email author
  • Judy A. Greene
    • 1
  • Rachel Gerson
    • 1
  • Michele Pollock
    • 1
  • Kimberly E. Hoagwood
    • 1
  • Sarah McCue Horwitz
    • 1
  1. 1.New York University School of MedicineNew YorkUSA

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