Screening at 2 Months Identifies Most Women With Postpartum Depression

Using a well-child visit to screen for postpartum depression 2 months after delivery will catch the majority of women likely to develop the condition within the first 6 postpartum months, new research suggests.

Investigators at the University of Colorado Denver School of Medicine also found that using cues embedded in the electronic medical records of infants 0 to 6 months of age to remind physicians to screen new mothers is an effective method of detecting and referring those at risk.

"This study demonstrates that it is feasible to screen adolescent mothers for postpartum depression at their infant's well-child visits during the first 6 postpartum months, and it provides new insights into the utility of doing so," the investigators, with lead author Jeanelle Sheeder, write.

The study is published in the June issue of Pediatrics.

No Optimal Screening Interval Identified

Postpartum depression is the most common medical problem new mothers face and is associated with a wide range of maternal and child health problems. It can develop any time during the first postpartum year, and while pediatric visits have been identified as an ideal setting in which to screen women, there is no evidence to support an optimal screening interval, the authors note.

The purpose of the study was to assess the feasibility of using electronically generated reminders to detect and refer at-risk women and to look at the prevalence and incidence of maternal depression assessed at well-child visits during the first 6 months after birth.

The study included 204 mothers and 413 electronic depression–screening cues. These prompts appeared automatically when the medical records of children 0 to 6 months old were opened and reminded medical staff to administer the 10-item Edinburgh Postpartum Depression Scale (EPDS) to new mothers.

Providers were unable to close the children's medical records until they had entered the EPDS score or 1 of the precoded reasons for not administering the EPDS.

An EPDS of 10 or greater was considered a positive result, and providers could not close the medical record until a management plan or referral was recorded.

The providers administered the EPDS 98% of the time and always referred mothers with positive scores. Overall, 20.1% of the women who completed the EPDS at 2 weeks, 2 months, 4 months, or 6 months had positive scores.

EPDS scores indicated that the prevalence of depressive symptoms varied from 17.0% at 2 weeks to 16.5% at 2 months.

Screening Before 2 Months Not Useful

The researchers also found that screening for depression during the first 3 weeks was so unreliable that it could not consistently identify the same mothers as being at risk for depression. This finding, the researchers note, argues against routine, universal postpartum depression screening before 2 months.

After 3 weeks, the prevalence and incidence of positive EPDS scores decreased from 16.5% at 2 months to 10.3% and 5.7% respectively at 4 months. However, prevalence increased to 18.5% at the 6-month visit and incidence decreased to 1.9%, the investigators report.

The authors note that if women had been screened only at the 2-month postpartum time point, only 2 of the 35 mothers with positive EPDS scores at 6 months would have been missed. Both of those mothers completed the EPDS within 3 weeks after delivery, but neither crossed the referral threshold.

"Although more frequent screenings would be optimal, if our findings are substantiated it would be most expedient for pediatric or obstetric providers to screen mothers for depression at least once — 2 months after birth," the investigators write.