Long-term outcomes of participants in a perinatal depression early detection program

Reay, Rebecca; Matthey, Stephen; Ellwood, David; Scott, Maureen J

doi:10.1016/j.jad.2010.07.035

Cited by 71 publications

(61 citation statements)

References 57 publications

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“…14,[33][34][35] Gjerdingen et al clearly stated the problems they experienced in referring postpartum women from primary care sites to mental health practices for SCID assessment and diagnosis even when management was returned to the primary care site. 36 In a broadly implemented program of screening and follow-up in Australia, only about 50% of women had even the initial step of postpartum depression screening.…”

Section: P Os T Pa R T U M Depr Es Sion Scr Eening a Nd M A Nagementmentioning

confidence: 99%

TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management

Yawn

Dietrich²,

Wollan³

et al. 2012

The Annals of Family Medicine

128

168

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PURPOSE Postpartum depression is common but inadequately recognized and undertreated. Continuing depressive symptoms are associated with adverse outcomes for the woman, her infant, and family. We wanted to determine the effect of a practice-based training program for screening, diagnosis, and management of depression in postpartum mothers. METHODSIn this practice-based effectiveness study, 28 practices were randomized to usual care (n = 14) or intervention (n = 14), and 2,343 women were enrolled between 5 and 12 weeks' postpartum. The intervention sites received education and tools for postpartum depression screening, diagnosis, initiation of therapy, and follow-up within their practices. Usual-care practices received a 30-minute presentation about postpartum depression. Screening information for the usual care was obtained from baseline surveys sent directly to the central site but was not available for patient care. Outcomes were based on patient-reported outcomes (level of depressive symptoms) from surveys at 6 and 12 months, plus medical record review (diagnosis and therapy initiation). RESULTSAmong the 2,343 women enrolled, 1,897 (80.1%) provided outcome information, and were included in the analysis. Overall, 654 (34.5% of 1,897) women had elevated screening scores indicative of depression, with comparable rates in the intervention and usual-care groups. Among the 654 women with elevated postpartum depression screening scores, those in the intervention practices were more likely to receive a diagnosis (P = .0006) and therapy for postpartum depression (P = .002). They also had lower depressive symptom levels at 6 (P = .07) and 12 months' (P = .001) postpartum.CONCLUSIONS Primary care-based screening, diagnosis, and management improved mother's depression outcomes at 12 months. This practical approach could be implemented widely with modest resources.

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Section: P Os T Pa R T U M Depr Es Sion Scr Eening a Nd M A Nagementmentioning

confidence: 99%

TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management

Yawn

Dietrich²,

Wollan³

et al. 2012

The Annals of Family Medicine

128

168

View full text Add to dashboard Cite

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“…[2][3][4][5][6] Neither the United States Preventive Services Task Force nor the American College of Obstetrics and Gynecology has made recommendations regarding routine PPD screening. 7,8 The American Academy of Pediatrics, however, recommends universal screening in the early postpartum period and screening for parental depression at each well-child visit.…”

Section: Introductionmentioning

confidence: 99%

Repeated Depression Screening During the First Postpartum Year

Yawn

Bertram

Kurland

et al. 2015

The Annals of Family Medicine

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PURPOSE Postpartum depression (PPD) screening at 4 to 12 weeks' postpartum can improve outcomes for women when linked to in-practice management programs. The benefit of repeated PPD screening during the first year postpartum remains unclear. METHODSWe report a substudy of a large pragmatic trial of early PPD screening and practice management, the Translating Research into Practice for Postpartum Depression (TRIPPD) study. Outcome analyses were based on demographic information and Patient Health Questionnaire (PHQ-9) screening scores from questionnaires mailed to all enrolled women at baseline (4 to 12 weeks' postpartum) and again at 6 and at 12 months' postpartum. The main outcomes of this substudy were the 6-and 12-month rates of PHQ-9 scores that were 10 or greater for women whose baseline PHQ-9 scores were less than 10. Women whose scores were 10 or greater would be considered at high risk of PPD and appropriate for further evaluation.RESULTS At 6 months, 134 (10.9%) of the 1,235 women who did not have PHQ-9 scores greater than 10 at baseline had elevated scores appropriate for further evaluation. At 12 months, 59 (6.1%) of the 969 women who did not have PHQ-9 scores greater than 10 at baseline or at 6 months had elevated scores. Together the 6-and 12-month repeated screenings identified 193 women at high risk of depression. This finding represents 13.5% of the 1,432 women whose screening results were negative for PPD at baseline. CONCLUSIONSRepeated PPD screening at 6 and 12 months' postpartum increases the percentage of women identified as being at high risk of PPD. Further work will be required to understand the impact of this repeated screening on patient outcomes. Ann Fam Med 2015;13:228-234. doi: 10.1370/afm.1777. INTRODUCTIONM aternal postpartum depression (PPD) is common, costly, and associated with adverse outcomes for mothers, infants, and families.1,2 There is limited outcomes-based evidence to support universal or routine PPD screening in the early postpartum period. [2][3][4][5][6] Neither the United States Preventive Services Task Force nor the American College of Obstetrics and Gynecology has made recommendations regarding routine PPD screening. 7,8 The American Academy of Pediatrics, however, recommends universal screening in the early postpartum period and screening for parental depression at each well-child visit.9,10 The basis for those recommendations appears to be evidence that PPD is currently underrecognized, 10,11 that screening increases recognition, 10,12 and that pediatricians can discuss and refer women at risk for depression. 10,13The need to evaluate rescreening is based in part on the natural history of PPD as reported in a meta-analysis by Gaynes et al of 28 studies that included about 15,000 women.1 The prevalence of PPD diagnosis based on assessment by clinical interviews was 3.8% at 4 weeks, increasing to 4.7% at 12 weeks, and 5.6% at 26 weeks. Rates then fell to 1.0% at 32 weeks and 3.9% at 52 weeks. The increasing prevalence of PPD up to 6 months' postpartum sugges...

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“…Although research in this area is just beginning in pediatrics, we can learn from maternal depression management systems in obstetrics and family medicine settings where numerous intervention studies have shown efficacy (41)(42)(43)(44)(45)(46)(47)(48)(49). These clinics vary in the types of providers they employ, from obstetricians to mother-only general practitioners to maternal-child clinics but all differ from the pediatric models in that the providers are already the women's providers (as opposed to her children's).…”

Section: Lessons In Maternal Depression Management To Be Learned Frommentioning

confidence: 99%

Beyond screening: a review of pediatric primary care models to address maternal depression

et al. 2015

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Depression is one of the most debilitating chronic disorders in the United States, affecting 15 million children in homes with depressed mothers, many of whom endure household chaos, inconsistent nurturing, inadequate safety practices, and harsh discipline. Depressed mothers are under diagnosed and undertreated, yet there is broad consensus about the importance of identifying and managing maternal depression, as reflected in recommendations by pediatric and obstetric professional organizations to routinely screen for perinatal depression. Screening was shown to be acceptable to women and most pediatric providers, and adding a screening component need not impair clinic efficiency. Screening, however, is not sufficient, and there are few models in the literature to guide medical practices in implementing successful interventions to identify, treat, and prevent maternal depression, particularly in the pediatric setting. We reviewed the literature and identified six studies that evaluated models for screening and managing mothers' depression in pediatric primary care settings. Some of these interventions have promise, but no studies characterized health outcomes of the depressed mothers and children. We discuss the components of these models, their implementation, and the practice and research needed to create effective pediatrics-based systems to reduce the negative effects of maternal depression on mothers, children, and families.D epression is one of the most debilitating chronic disorders in the United States (1), a fact experienced every day by the 15 million children being raised in homes with depressed mothers (2). Children living with depressed mothers may experience household chaos, inconsistent nurturing, inadequate safety practices, harsh discipline, and child maltreatment (3,4). Compared to nonexposed peers, children of depressed mothers are two to three times more likely to develop psychiatric disorders themselves and to do poorly in school (5-9). Moreover, recent studies suggest that remission of maternal depression is associated with significant improvement in child behavioral and mental health outcomes (10). Children's home, family, and social environments appear to explain the majority of the risk for the intergenerational transmission of depression (11), with genetics contributing less than half of the risk (10,12). It is the immediate family environment, what Bronfenbrenner refers to as "proximal processes, " that powerfully shapes children's neural, cognitive, social, and behavioral development (13). Thus, it is imperative to promote the safety and wellbeing of children living in homes with depressed mothers.According to the 2009 US National Academies of Science review of maternal depression, "Few opportunities exist to identify the vulnerable population of children living in households with one or more parents experiencing depression or to offer prevention and treatment services that can improve the care of the depressed parent in a framework that also offers services for children" (2). The pedi...

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Long-term outcomes of participants in a perinatal depression early detection program

Abstract: Despite being offered treatment options, a substantial proportion of women who screened positive had poor long-term mental health and relationship outcomes. This paper discusses some of the implications for perinatal early detection and treatment programs.

Cited by 71 publications

References 57 publications

TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management

TRIPPD: A Practice-Based Network Effectiveness Study of Postpartum Depression Screening and Management

Repeated Depression Screening During the First Postpartum Year

Beyond screening: a review of pediatric primary care models to address maternal depression

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