The Impact of a Brief Obstetrics Clinic-Based Intervention on Treatment Use for Perinatal Depression

Abstract

Objective: The purpose of this study was to examine the association of prenatal depression screening and obstetrics clinician notification procedures with depression treatment use through 6 weeks postpartum. Methods: An initial sample of 1298 women was screened for depression as part of routine clinical care at their first prenatal care appointment using the Edinburgh Postnatal Depression Scale (EPDS) at a university hospital obstetrics clinic in the United States. Women with an EPDS > 10 who agreed to participate in this longitudinal study completed assessments of depression and treatment use throughout pregnancy and through 6 weeks postpartum. Following screening and prior to their second prenatal visit, all women scoring ≥ 10 on the EPDS received nurse-delivered depression feedback and referral, and all treating physicians were notified of the elevated EPDS status (i.e., ≥ 10) of their patients. Results: The majority (65%) of pregnant women with current major depressive disorder (MDD) were not receiving any depression treatment throughout the study period. Overall, women with EDPS ≥ 10 who reported that their physician discussed depression with them (67%) were significantly more likely to seek treatment (compared with those who did not report physician discussion of depression with them) by the 1 month prenatal follow-up but not by the 6 weeks postpartum follow-up. Initial depression severity and treatment use prior to screening were the strongest predictors of subsequent depression treatment use. Conclusions: Depression screening combined with systematic clinician follow-up showed a modest short-term impact on depression treatment use for perinatal depression but did not affect depression outcomes. Most women with MDD were not engaged in treatment throughout the follow-up period despite the interventions. More intensive and repeated monitoring might enhance the effect of clinician interventions to improve treatment use.