A systematic review of interventions for healthcare professionals to improve screening and referral for perinatal mood and anxiety disorders

Abstract

Postpartum depression affects approximately 11% of women. However, screening for perinatal mood and anxiety disorders (PMAD) is rare and inconsistent among healthcare professionals. When healthcare professionals screen, they often rely on clinical judgment, rather than validated screening tools. The objective of the current study is to review the types and effectiveness of interventions for healthcare professionals that have been used to increase the number of women screened and referred for PMAD. Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to guide search and reporting strategies. PubMed/Medline, PsychInfo/PsychArticles, Cumulative Index to Nursing, Allied Health Literature (CINAHL), and Health Source: Nursing/Academic Edition databases were used to find studies that implemented an intervention for healthcare professionals to increase screening and referral for PMAD. Twenty-five studies were included in the review. Based on prior quality assessment tools, the quality of each article was assessed using an assessment tool created by the authors. The four main outcome variables were the following: percentage of women screened, percentage of women referred for services, percentage of women screened positive for PMAD, and provider knowledge, attitudes, and/or skills concerning PMAD. The most common intervention type was educational, with others including changes in electronic medical records and standardized patients for training. Study quality and target audience varied among the studies. Interventions demonstrated moderate positive impacts on screening completion rates, referral rates for PMAD, and patient-provider communication. Studies suggested positive receptivity to screening protocols by mothers and providers. Given the prevalence and negative impacts of PMAD on mothers and children, further interventions to improve screening and referral are needed.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. Ahmed HM, Alalaf SK, Al-Tawil NG (2012) Screening for postpartum depression using Kurdish version of Edinburgh postnatal depression scale. Arch Gynecol Obstet 285(5):1249–1255

    PubMed  Article  Google Scholar 

  2. American College of Obstetricians and Gynecologists (2015) Screening for perinatal depression. Committee opinion no. 630. Obstet Gynecol 125:1268–1271

    Article  Google Scholar 

  3. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington, VA: American Psychiatric Publishing

  4. Avalos LA, Raine-Bennett T, Chen H, Adams AS, Flanagan T (2016) Improved perinatal depression screening, treatment, and outcomes with a universal obstetric program. Obstet Gynecol 127(5):917–925

    PubMed  PubMed Central  Article  Google Scholar 

  5. Bakeman R, Gottman JM (1997) Assessing observer agreement. In: Observing interaction: an introduction to sequential analysis, 2nd edn. Cambridge University Press, New York, pp 56–80

    Google Scholar 

  6. Baker CD, Kamke H, O’hara MW, Stuart S (2009) Web-based training for implementing evidence-based management of postpartum depression. J Am Board Fam Med 22(5):588–589

    PubMed  Article  Google Scholar 

  7. Baker-Ericzen MJ, Mueggenborg MG, Hartigan P, Howard N, Wilke T (2008) Partnership for women’s health: a new-age collaborative program for addressing maternal depression in the postpartum period. Fam, Syst & Health 26(1):30–44

    Article  Google Scholar 

  8. Bauer SC, Smith PJ, Chien AT, Berry AD, Msall M (2009) Educating pediatric residents about developmental and social–emotional health. Infants & Young Children 22(4):309–320

    Article  Google Scholar 

  9. Bodnar-Deren S, Klipstein K, Fersh M, Shemesh E, Howell EA (2016) Suicidal ideation during the postpartum period. J Women's Health 25(12):1219–1224

    Article  Google Scholar 

  10. Centers for Disease Control and Prevention (CDC) (2017, February 15) Depression among women. Retrieved from http://www.cdc.gov/reproductivehealth/depression/index.htm

  11. Chadha-Hooks PL, Park JH, Hilty DM, Seritan AL (2010) Postpartum depression: an original survey of screening practices within a healthcare system. J Psychosom Obstet Gynaecol 31(3):199–205

    PubMed  Article  Google Scholar 

  12. Chaudron LH, Szilagyi PG, Kitzman H, Wadkins HI, Conwell Y (2004) Detection of postpartum depressive symptoms by screening at well-child visits. Pediatr 113(3):551–558

    Article  Google Scholar 

  13. Connelly CD, Baker MJ, Hazen AL, Mueggenborg MG (2007) Pediatric health care providers’ self-reported practices in recognizing and treating maternal depression. Pediatr Nurs 33(2):165–172

    PubMed  Google Scholar 

  14. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British J Psychiatry 150(6):782–786

    CAS  Article  Google Scholar 

  15. Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  16. Earls MF, Committee on Psychosocial Aspects of Child and Family Health (2010) Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatr 126(5):1032–1039

    Article  Google Scholar 

  17. Eastwood JG, Jalaludin BB, Kemp LA, Phung HN, Barnett BE (2012) Relationship of postnatal depressive symptoms to infant temperament, maternal expectations, social support and other potential risk factors: findings from a large Australian cross-sectional study. BMC Pregnancy Childbirth 12(1):148

    PubMed  PubMed Central  Article  Google Scholar 

  18. Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Ove Samuelsen S (2001) Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand 104(4):243–249

    CAS  PubMed  Article  Google Scholar 

  19. Effective Public Health Practice Project. (1998). Quality assessment tool for quantitative studies. Hamilton, ON: Effective Public Health Practice Project. Retrieved from: http://www.ephpp.ca/index.html

  20. Escribà-Agüir V, Artazcoz L (2011) Gender differences in postpartum depression: a longitudinal cohort study. J Epidemiol Community Health 65(4):320–326

    PubMed  Article  Google Scholar 

  21. Evans MG, Phillippi S, Gee RE (2015) Examining the screening practices of physicians for postpartum depression: implications for improving health outcomes. Womens Health Issues 25(6):703–710

    Article  Google Scholar 

  22. Feinberg E, Smith MV, Morales MJ, Claussen AH, Smith DC, Perou R (2006) Improving women’s health during internatal periods: developing an evidenced-based approach to addressing maternal depression in pediatric settings. J Women's Health 15(6):692–703

    Article  Google Scholar 

  23. Ferber SG, Feldman R, Makhoul IR (2008) The development of maternal touch across the first year of life. Early Hum Dev 84(6):363–370

    PubMed  Article  Google Scholar 

  24. First MB (1997) Structured clinical interview for the DSM-IV axis I disorders: SCID-I/P, version 2.0. New York: Biometrics Research Dept., New York State Psychiatric Institute

  25. Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C (2014) Predictors of postpartum depression: prospective study of 264 women followed during pregnancy and postpartum. Psychiatry Res 215(2):341–346

    PubMed  Article  Google Scholar 

  26. Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes: Summary

  27. Georgiopoulos AM, Bryan TL, Wollan P, Yawn BP (2001) Routine screening for postpartum depression. J Family Practice 50(2):117–117

    CAS  Google Scholar 

  28. Goodman JH, Tyer-Viola L (2010) Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Women's Health 19(3):477–490

    Article  Google Scholar 

  29. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D (2011) Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 14(1):1–27

    PubMed  Article  Google Scholar 

  30. Gordon TE, Cardone IA, Kim JJ, Gordon SM, Silver RK (2006) Universal perinatal depression screening in an Academic Medical Center. Obstet Gynecol 107(2, Part 1):342–347

    PubMed  Article  Google Scholar 

  31. Heneghan AM, Chaudron LH, Storfer-Isser A, Park ER, Kelleher KJ, Stein RE, Horwitz SM (2007) Factors associated with identification and management of maternal depression by pediatricians. Pediatr 119(3):444–454

    Article  Google Scholar 

  32. Horowitz JA, Cousins A (2006) Postpartum depression treatment rates for at-risk women. Nurs Res 55(2):S23–S27

    PubMed  Article  Google Scholar 

  33. Horowitz JA, Murphy CA, Gregory KE, Wojcik J (2011) A community-based screening initiative to identify mothers at risk for postpartum depression. J Obstet, Gynecol, Neonatal Nurs 40(1):52–61

    Article  Google Scholar 

  34. Koo TK, Li MY (2016) A guideline for selecting and reporting intraclass correlation coefficients for reliability research. J Chiropractic Medicine 15:155–163

    Article  Google Scholar 

  35. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. Gen Intern Med 16:606–613

    CAS  Article  Google Scholar 

  36. Kroenke K, Spitzer RL, Williams JB (2003) The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 41(11):1284–1292

    PubMed  Article  Google Scholar 

  37. Leddy M, Haaga D, Gray J, Schulkin J (2011) Postpartum mental health screening and diagnosis by obstetrician-gynecologists. J Psychosom Obstet Gynaecol 32(1):27–34

    PubMed  Article  Google Scholar 

  38. Lind A, Richter S, Craft C, Shapiro AC (2017) Implementation of routine postpartum depression screening and care initiation across a multispecialty health care organization: an 18-month retrospective analysis. Matern Child Health J 21(6):1234–1239

    PubMed  Article  Google Scholar 

  39. Lopez LV, Shaikh A, Merson J, Greenberg J, Suckow RF, Kane JM (2017) Accuracy of clinician assessments of medication status in the emergency wetting: a comparison of clinician assessment of antipsychotic usage and plasma level determination. J Clin Psychopharmacol 37(3):310–314

    PubMed  Article  Google Scholar 

  40. Lovejoy MC, Graczyk PA, O’Hare E, Neuman G (2000) Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev 20(5):561–592

    CAS  PubMed  Article  Google Scholar 

  41. Mancini F, Carlson C, Albers L (2007) Use of the Postpartum Depression Screening Scale in a collaborative obstetric practice. J Midwifery Women’s Health 52(5):429–434

    Article  Google Scholar 

  42. Marshall M, Lockwood A, Bradley C, Adams C, Joy C, Fenton M (2000) Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia. British J Psychiatry 176(3):249–252

    CAS  Article  Google Scholar 

  43. Martins C, Gaffan EA (2000) Effects of early maternal depression on patterns of infant-mother attachment: a meta-analytic investigation. J Child Psychol Psychiatry 41(6):737–746

    CAS  PubMed  Article  Google Scholar 

  44. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    PubMed  PubMed Central  Article  Google Scholar 

  45. Neal T, Brodsky SL (2016) Forensic psychologists’ perceptions of bias and potential correction strategies in forensic mental health evaluations. Psychol, Public Policy, Law 22(1):58–76

    Article  Google Scholar 

  46. Olson AL, Dietrich AJ, Prazar G, Hurley J, Tuddenham A, Hedberg V, Naspinsky DA (2005) Two approaches to maternal depression screening during well child visits. J Dev Behav Pediatr 26(3):169–176

    PubMed  Article  Google Scholar 

  47. Osborn MA (2012) Training health visiting support staff to detect likelihood of possible postnatal depression. Community Practitioner 85(4):24–27

    PubMed  Google Scholar 

  48. Paulson JF, Dauber S, Leiferman JA (2006) Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics 118(2):659–668

    PubMed  Article  Google Scholar 

  49. Rowan P, Greisinger A, Brehm B, Smith F, McReynolds E (2012) Outcomes from implementing systematic antepartum depression screening in obstetrics. Arch Women’s Ment Health 15(2):115–120

    Article  Google Scholar 

  50. Schaar GL, Hall M (2013) A nurse-led initiative to improve obstetricians’ screening for postpartum depression. Nurs for Women's Health 17(4):306–316

    Article  Google Scholar 

  51. Schillerstrom JE, Lutz ML, Ferguson DM, Nelson EL, Parker JA (2013) The women’s health objective structured clinical exam: a multidisciplinary collaboration. J Psychosom Obstet Gynecol 34(4):145–149

    Article  Google Scholar 

  52. Segre LS, Davis WN (2013) Postpartum depression and perinatal mood disorders in the DSM. Postpartum Support Int

  53. Segre LS, Pollack LO, Brock RL, Andrew JR, O'Hara MW (2014) Depression screening on a maternity unit: a mixed-methods evaluation of nurses’ views and implementation strategies. Issues Ment Health Nurs 35(6):444–454

    PubMed  Article  Google Scholar 

  54. Sheeder J, Kabir K, Stafford B (2009) Screening for postpartum depression at well-child visits: is once enough during the first 6 months of life? Pediatr 123(6):e982–e988

    Article  Google Scholar 

  55. Smith T, Kipnis G (2012) Implementing a perinatal mood and anxiety disorders program. MCN: Am J Matern/Child Nursing 37(2):80–85

    Google Scholar 

  56. Talmi A, Stafford B, Buchholz M (2009) Providing perinatal mental health services in pediatric primary care. Zero to Three (J) 29(5):10–16

    Google Scholar 

  57. Thiam MA, Weis KL (2017) Perinatal mental health and the military family: identifying and treating mood and anxiety disorders. Routledge, Taylor & Francis Group, New York

  58. Thomason E, Stacks AM, McComish JF (2010) Early intervention and perinatal depression: is there a need for provider training? Early Child Dev Care 180(5):671–683

    Article  Google Scholar 

  59. Tucker P, Crow S, Cuccio A, Schleifer R, Vannatta JB (2004) Helping medical students understand postpartum psychosis through the prism of “the yellow wallpaper” by Charlotte Perkins Gilman. Acad Psychiatry 28(3):247–250

    PubMed  Article  Google Scholar 

  60. Venkatesh KK, Nadel H, Blewett D, Freeman MP, Kaimal AJ, Riley LE (2016) Implementation of universal screening for depression during pregnancy: feasibility and impact on obstetric care. American J Obstet Gynecol 215(4):517–5e1

    Article  Google Scholar 

  61. Wiley CC, Burke GS, Gill PA, Law NE (2004) Pediatricians’ views of postpartum depression: a self-administered survey. Arch Women’s Ment Health 7:231–236

    CAS  Article  Google Scholar 

  62. Wisner KL, Logsdon MC, Shanahan BR (2008) Web-based education for postpartum depression: conceptual development and impact. Arch Women’s Ment Health 11(5–6):377–385

    Article  Google Scholar 

  63. Yawn BP, Dietrich AJ, Wollan P, Bertram S, Graham D, Huff J, Kurland M, Madison S, Pace WD, practices TRIPPD (2012) TRIPPD: a practice-based network effectiveness study of postpartum depression screening and management. Ann Fam Med 10(4):320–329

    PubMed  PubMed Central  Article  Google Scholar 

  64. Yonkers KA, Smith DPMV, Lin H, Howell HB, Shao L, Rosenheck RA (2009) Depression screening of perinatal women: an evaluation of the healthy start depression initiative. Psychiatr Serv 60(3):322–328

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Molly M. Long.

Electronic supplementary material

ESM 1

(DOCX 15 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Long, M.M., Cramer, R.J., Jenkins, J. et al. A systematic review of interventions for healthcare professionals to improve screening and referral for perinatal mood and anxiety disorders. Arch Womens Ment Health 22, 25–36 (2019). https://doi.org/10.1007/s00737-018-0876-4

Download citation

Keywords

  • Postpartum depression
  • PMAD
  • Intervention
  • Screening
  • Referral