Background: Postpartum depression occurs in 10% to 20% of women who have recently given birth, but fewer than half of cases are recognized. The purpose of this review is to discuss the potential benefit of mass screening for improving postpartum depression recognition and outcomes.Methods: A review of the literature was conducted by searching MEDLINE, using the key words "depression," "postpartum depression," and "mass screening." The Cochrane database was also searched for reviews on depression and postpartum depression.Results: Opportunities for routine postpartum depression screening include mothers' postpartum office visits and their infants' well-child visits. Although several depression screens have been used in postpartum women, additional studies using large representative samples are needed to identify the ideal screening tool. Depression screening plus "high-risk" feedback to providers improves the recognition of depression. However, for screening to positively impact clinical outcomes, it needs to be combined with systems-based enhanced depression care that provides accurate diagnoses, strong collaborative relationships between primary care and mental health providers, and longitudinal case management, to assure appropriate treatment and follow-up. Depression is common and costly, particularly for women in their childbearing years. The World Health Organization has identified major depression as the fourth leading cause of burden among all diseases, and the leading cause of years lived with disability.
Conclusions: Postpartum depression screening improves recognition of the disorder, but improvement in clinical outcomes1 It is estimated that depression costs the United States $30 billion to $50 billion in lost productivity and direct medical costs each year.2 By 2020, depressive illness is expected to be the second leading cause of disability in the world.3 The burden is greatest for women, with a lifetime risk for major depressive disorder of 20% to 25%, approximately twice the 7% to 12% rate seen with men. 4 In the first 3 months after childbirth, 14.5% of women have a new episode of major or minor depression, 5 and 10% to 20% of mothers are believed to suffer with depression sometime during their postpartum course, 6 making postpartum depression the most common serious postpartum disorder.There is some controversy about whether rates of depression increase after delivery, and whether postpartum depression is a distinct entity from nonpostpartum depression. A British case-control study of mothers from 4 general practices found a 3-fold higher incidence of depression within 5 weeks after childbirth.7 Similarly, a Norwegian study comparing postpartum with nonpostpartum women found a 1.8-fold greater risk for depression in postpartum women.8 However, other researchers have not found the risk of depression to be an higher in postpartum women, compared with other young women, suggesting that postpartum depression may not be a distinct condition but merely major depression recognized at a time of potentia...