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Screening for Postpartum Depression Among Low-Income Mothers Using an Interactive Voice Response System

Abstract

This study tested the feasibility of using an interactive voice response (IVR) phone system to screen for postpartum depression among low-income, English- and Spanish-speaking mothers. Newly delivered mothers were interviewed in the hospital. Consenting subjects completed a background questionnaire and were asked to call an automated phone system 7 days postpartum to complete an IVR version of the Edinburgh Postnatal Depression Screen (EPDS). During the phone screen, subjects were branched to different closing narratives based on their depression scores which were later posted to a password protected website. Logistic regression was used to assess relationships between demographic and psychosocial factors, IVR participation, and depression scores. Among 838 ethnically diverse, low income, postpartum mothers, 324 (39%) called into the automated phone screening system. Those who called were more likely to have at least a high school education (OR = 1.63, 95%CI: 1.23, 2.16), be employed (OR = 1.48, 95%CI: 1.08, 2.03) and have food secure households (OR = 1.50, 95%CI: 1.06, 2.13). There was no statistically significant difference between callers and non-callers in terms of marital status, race/ethnicity, parity, or self-reported history of depression. Postpartum depression symptoms were present in 17% (n = 55) and were associated with being single (AOR = 2.41, 95% CI: 1.29, 4.50), first time mother status (AOR = 2.43, 95% CI: 1.34, 4.40), temporary housing (AOR = 2.35, 95% CI: 1.30, 4.26), history of anxiety (AOR = 2.79, 95% CI: 1.69, 6.67), and history of self-harm (AOR = 2.66, 95% C: 1.01, 6.99). Automated phone screening for postpartum depression is feasible among disadvantaged mothers but those with the highest psychosocial risk factors may not choose or be able to access it. IVR could be used to supplement office- and home visit-based screening protocols and to educate patients about mental health resources.

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References

  1. Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of depressed mood during pregnancy and after childbirth. British Medical Journal, 323, 257–260.

    PubMed  Article  CAS  Google Scholar 

  2. Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron, R. P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consult and Clinical Psychology, 63, 445–453.

    Article  CAS  Google Scholar 

  3. Morris-Rush, J. K., Freda, M. C., & Bernstein, P. S. (2003). Screening for postpartum depression in an inner-city population. American Journal of Obstetrics and Gynecology, 188, 1217–1219.

    PubMed  Article  Google Scholar 

  4. Dale, F., Hay, P. A., Mills, A., Kumar, R., Pawlby, S., & Sharp, D. (2001). Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 42, 871–889.

    Article  Google Scholar 

  5. Essex, M. J., Klein, M. H., Miech, R., & Smider, N. A. (2001). Timing of initial exposure to maternal major depression and children’s mental health symptoms in kindergarten. British Journal of Psychiatry, 179, 151–156.

    PubMed  Article  CAS  Google Scholar 

  6. Davilla, M., McFall, S. L., & Cheng, D. (2008). Acculturation and depressive symptoms among pregnant and postpartum Latinas. Maternal and Child Health Journal, 13, 318–325.

    Article  Google Scholar 

  7. Chaudron, L. H., Kitzman, H. J., Peifer, K. L., Morrow, S., Perez, L. M., & Newman, M. C. (2005). Prevalence of maternal depressive symptoms in low-income Hispanic women. Journal of Clinical Psychiatry, 66(4), 418–423.

    PubMed  Article  Google Scholar 

  8. Federenko, I. S., & Wadhwa, P. D. (2004). Women’s mental health during pregnancy influences fetal and infant developmental and health outcomes. CNS Spectrums, 9, 198–206.

    PubMed  Google Scholar 

  9. Wisner, K. L., Chambers, C., & Sit, D. K. (2006). Postpartum depression: A major public health problem. JAMA, 296(21), 2616–2618.

    PubMed  Article  CAS  Google Scholar 

  10. Miranda, J., Chung, J. Y., Green, B. L., Krupnick, J., Siddique, J., Revicki, D. A., et al. (2003). Treating depression in predominantly low-income young minority women: A randomized controlled trial. JAMA, 290, 57–65.

    PubMed  Article  Google Scholar 

  11. Alvidrez, J., & Azocar, F. (1999). Distressed women’s clinic patients: Preferences for mental health treatments and perceived obstacles. General Hospital Psychiatry, 21, 340–347.

    PubMed  Article  CAS  Google Scholar 

  12. Rudd, R. E., Kaphingst, K., Colton, T., Gregoire, J., & Hyde, J. (2004). Rewriting public health information in plain language. Journal of Health Communication, 9(3), 195–206.

    PubMed  Article  Google Scholar 

  13. Kirsch, I. S., Jungeblut, A., Jenkins, L., & Kolstad, A. (1993). Adult literacy in America: A first look at the findings of the National Adult Literacy Survey. Washington, DC: National Center for Education Statistics, US Department of Education.

    Google Scholar 

  14. Williams, M. V., Parker, R. M., Baker, D. W., Parikh, N. S., Pitkin, K., Coates, W. C., et al. (1995). Inadequate functional health literacy among patients at 2 public hospitals. JAMA, 274, 1677–1682.

    PubMed  Article  CAS  Google Scholar 

  15. Jimison, H., Gorman, P., Woods, S., Nygren, P., Walker, M., Norris, S., Hersh, W. (2008). Barriers and drivers of health information technology use for the elderly, chronically ill, and underserved. Evidence Report/Technology Assessment No. 175 (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-02-0024). AHRQ Publication No. 09-E004. Rockville, MD: Agency for Healthcare Research and Quality.

  16. Piette, J. D. (2000). Interactive voice response systems in the diagnosis and management of chronic disease. American Journal of Managed Care, 6(7), 817–827.

    PubMed  CAS  Google Scholar 

  17. Piette, J. D. (2000). Interactive voice response systems in the diagnosis and management of chronic disease. American Journal of Managed Care, 6(7), 817–827.

    PubMed  CAS  Google Scholar 

  18. Cole, S. A., Farber, N. C., Weiner, J. S., Sulfaro, M., Katzelnick, D. J., & Blader, J. C. (2006). Double-disease management or one care manager for two chronic conditions: Pilot feasibility study of nurse telephonic disease management for depression and congestive heart failure. Disease Management, 9(5), 266–276.

    PubMed  Article  Google Scholar 

  19. Turvey, C. L., Willyard, D., Hickman, D. H., Klein, D. M., & Kukoyi, O. (2007). Telehealth screen for depression in a chronic illness care management program. Telemedicine Journal and E-Health, 13(1), 51–56.

    PubMed  Article  Google Scholar 

  20. Heisler, M., Halasyamani, L., Resnicow, K., Neaton, M., Shanahan, J., Brown, S., et al. (2007). “I am not alone”: The feasibility and acceptability of interactive voice response-facilitated telephone peer support among older adults with heart failure. Congestive Heart Failure, 13(3), 149–157.

    PubMed  Article  Google Scholar 

  21. Greist, J. H., Mundt, J. C., & Kobak, K. A. (2002). Factors contributing to failed trials of new agents: Can technology prevent some problems? Journal of Clinical Psychiatry (Supplement), 63, 8–13.

    Google Scholar 

  22. Kaminer, Y., Litt, M. D., Burke, R. H., & Burleson, J. A. (2006). An interactive voice response (IVR) system for adolescents with alcohol use disorders: A pilot study. American Journal of Addiction, 15(Suppl 1), 122–125.

    Article  Google Scholar 

  23. Brodey, B. B., Rosen, C. S., Brodey, I. S., Sheetz, B., & Unutzer, J. (2005). Reliability and acceptability of automated telephone surveys among Spanish- and English-speaking mental health services recipients. Mental Health Services Research, 7(3), 181–184.

    PubMed  Article  Google Scholar 

  24. Rush, A. J., Bernstein, I. H., Trivedi, M. H., Carmody, T. J., Wisniewski, S., Mundt, J. C., et al. (2006). An evaluation of the quick inventory of depressive symptomatology and the hamilton rating scale for depression: A sequenced treatment alternatives to relieve depression trial report. Biological Psychiatry, 59, 493–501. Epub 2005 Sep 30.

    PubMed  Article  Google Scholar 

  25. Moore, H. K., Mundt, J. C., Modell, J. G., Rodrigues, H. E., DeBrota, D. J., Jefferson, J. J., et al. (2006). An examination of 26, 168 Hamilton depression rating scale scores administered via interactive voice response across 17 randomized clinical trials. Journal of Clinical Psychopharmacology, 26(3), 321–324.

    PubMed  Article  CAS  Google Scholar 

  26. Baer, L., Jacobs, D. G., Cukor, P., O’Laughlen, J., Coyle, J. T., & Magruder, K. M. (1995). Automated telephone screening survey for depression. JAMA, 273, 1943–1944.

    PubMed  Article  CAS  Google Scholar 

  27. Moore, H. K., Hughes, C. W., Mundt, J. C., Rush, A. J., Macleod, L., Emslie, G. J., et al. (2007). A pilot study of an electronic, adolescent version of the quick inventory of depressive symptomatology. Journal of Clinical Psychiatry, 68(9), 1436–1440.

    PubMed  Article  Google Scholar 

  28. Pinto-Meza, A., Serrano-Blanco, A., Peñarrubia, M. T., Blanco, E., & Haro, J. M. (2005). Assessing depression in primary care with the PHQ-9: Can it be carried out over the telephone? Journal of General Internal Medicine, 20(8), 738–742.

    PubMed  Article  Google Scholar 

  29. Rush, A. J., Bernstein, I. H., Trivedi, M. H., Carmody, T. J., Wisniewski, S., Mundt, J. C., Shores-Wilson, K., Biggs, M. M., Woo, A., Nierenberg, A. A., Fava, M. (2006). An evaluation of the quick inventory of depressive symptomatology and the Hamilton rating scale for depression: A sequenced treatment alternatives to relieve depression trial report. Biological Psychiatry, 59(6), 493–501. Epub 2005 Sep 30.

    Google Scholar 

  30. Kim, H., Bracha, Y., & Tipnis, A. (2007). Automated depression screening in disadvantaged pregnant women in an urban obstetric clinic. Archives of Women’s Mental Health, 10(4), 163–169.

    PubMed  Article  CAS  Google Scholar 

  31. Casey, P., Goolsby, S., Berkowitz, C., Frank, D., Cutts, D., Black, M. M., et al. (2004). Maternal depression, changing public assistance, food security, and child health status. Pediatrics, 113, 298–304.

    PubMed  Article  Google Scholar 

  32. 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.

    PubMed  Article  CAS  Google Scholar 

  33. Wisner, K. L., Parry, B. L., & Piontek, C. M. (2002). Postpartum depression. NEJM, 347(3), 194–199.

    PubMed  Article  Google Scholar 

  34. Peindl, K. S., Wisner, K. L., & Hanusa, B. H. (2004). Identifying depression in the first postpartum year: Guidelines for office-based screening and referral. Journal of Affective Disorders, 80(1), 37–44.

    PubMed  Article  Google Scholar 

  35. Yonkers, K. A., Ramin, S. M., Rush, A. J., Navarrete, C. A., Carmody, T., March, D., et al. (2001). Onset and persistence of postpartum depression in an inner-city maternal health clinic system. American Journal of Psychiatry, 158(11), 1856–1863.

    PubMed  Article  CAS  Google Scholar 

  36. Kurtz Landy, C., Sword, W., & Ciliska, D. (2008). Urban women’s socioeconomic status, health service needs and utilization in the four weeks after postpartum hospital discharge: Findings of a Canadian cross-sectional survey. BMC Health Services Research, 8, 203.

    PubMed  Article  Google Scholar 

  37. Gilbody, S., Sheldom, T., & House, A. (2008). Screening and case-finding instruments for depression: A meta-analysis. Canadian Medical Association Journal, 178(8), 997–1003.

    PubMed  Article  Google Scholar 

  38. Carter, F. A., Carter, J. D., Luty, S. E., Wilson, D. A., Frampton, C. M., & Joyce, P. R. (2005). Screening and treatment for depression during pregnancy: A cautionary note. Australian and New Zealand Journal of Psychiatry, 39(4), 255–261.

    PubMed  Article  Google Scholar 

  39. Smith, M. V., Shao, L., Howell, H., Wang, W., Poschman, K., & Yonkers, K. A. (2009). Success of mental health referral among pregnant and postpartum women with psychiatric distress. General Hospital Psychiatry, 31, 155–162.

    PubMed  Article  Google Scholar 

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Acknowledgments

This research was supported by a grant from the Minnesota Medical Research Foundation and the Department of Psychiatry, Hennepin County Medical Center. The authors wish to thank Dr. Michael K. Popkin for his ongoing support of the Hennepin Women’s Mental Health Program, and the participants and staff who contributed to the project.

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Correspondence to Helen G. Kim.

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Kim, H.G., Geppert, J., Quan, T. et al. Screening for Postpartum Depression Among Low-Income Mothers Using an Interactive Voice Response System. Matern Child Health J 16, 921–928 (2012). https://doi.org/10.1007/s10995-011-0817-6

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  • DOI: https://doi.org/10.1007/s10995-011-0817-6

Keywords

  • Postpartum depression
  • Interactive voice response
  • Mental health screening
  • Underserved women