Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative

Abstract

Objective: To address problems with low rates of detection and treatment of depression of pregnant and postpartum women, many advocate depression screening in obstetrical settings. This study evaluated the Healthy Start depression initiative to assess whether it resulted in diminished rates of depressive symptoms and increased rates of detection, referral, and treatment among pregnant and postpartum women. Methods: Three cohorts were used to examine the program impact: a pre–Healthy Start depression initiative cohort, a post–Healthy Start depression initiative cohort that was enrolled in New Haven Healthy Start, and a post–Healthy Start depression initiative cohort not enrolled in the New Haven program. Participants included 1,336 pregnant and postpartum women receiving obstetrical care at publicly funded health care clinics. Measures included the Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire; the PTSD Symptom Scale; a five-item modification of the Conflict Tactics Scale; and questions regarding alcohol, illicit substances, and general medical and obstetrical history. Results: The Healthy Start depression initiative changed neither levels of depressive symptoms nor use of depression treatment in unselected populations. The initiative may have decreased the rate of referral for depression in the cohort under study. Conclusions: Universal screening and support for treatment referral by paraprofessionals did not reduce the overall rates of depressive symptoms of perinatal women who received care at publicly funded obstetrical clinics. Future work on depression screening should consider strategies to engage women who are more severely affected by a depressive disorder in behavioral health treatment.

Perinatal Depression and Birth Outcomes in a Healthy Start Project

“…al. [16]) and included demographic (race/ethnicity, age, parity, education), interpersonal violence and substance use information. For this report, we used the demographic data as well as information about interpersonal violence and substance use.…”

Perinatal depression: a review of US legislation and law

“…In addition to legislative mandates to screen for perinatal depression, it is key to focus energy on educating health care and social services providers. To meet this educational need, perinatal depression researchers have developed a wide range of instructional approaches for health and social service providers, including web-based training (Baker, Kamke, O’Hara, and Stuart, 2009; Wisner, Logsdon, and Shanahan, 2008), one-to-one professional consultation (Chaudron, Szilagyi, Kitzman, Wadkins, and Conwell, 2004; Gordon, Cardone, Kim, Gordon, and Silver, 2006; Yonkers et al, 2009), and a “train-the-trainer” approach (Segre, Brock, O’Hara, Gorman, and Engeldinger, 2011). The additional federal funding issued by Section 2952 of the Patient Protection and Affordable Care Act will be critical in addressing the identified gaps on perinatal depression screening outcomes and in establishing an evidence base of best practices.…”

“…The results of two U.S. trials and one in France report that compared to either usual care (Chabrol et al 2002; Yawn et al 2012) or a historical control (Miller et al 2012), depression screening indeed prompted more affected women to initiate treatment. More importantly, when such studies compared universal screening to usual care, they found screening significantly improved outcomes in depressed mother (Chabrol et al 2002; Yawn et al 2012) Yet, the success of maternal depression screening programs has also been disputed by negative evaluation results both in terms of treatment initiation as well as maternal mood (Yonkers et al 2009). …”

New Jersey’s Efforts To Improve Postpartum Depression Care Did Not Change Treatment Patterns For Women On Medicaid

“…[10,35] Quality improvement in depression care has often required substantial investment of resources as well as direct incentives for change for both clinicians and patients. [27,36,37]…”