Patient engagement to examine perceptions of perinatal depression screening with the capabilities, opportunities, motivation, and behaviors (COM-B) model

Abstract

BackgroundPerinatal (during pregnancy and up until one year after birth) depression is one of the most common medical complications of pregnancy and is a major public health issue. The common early detection method to identify depression is to systematically administer depression screens to patients during their usual care clinic encounters. This study investigates how prenatal patients perceive depression screening and how screening informs their treatment to meet the specific needs of different racial and ethnic groups within both community and health care settings.MethodsBetween June 2019 and August 2019, semi-structured in-depth interviews were conducted to explore participants' experiences of depression screening with the Edinburgh Postnatal Depression Scale (EPDS). Perinatal women (N = 29) consented to participate in-depth, one-on-one qualitative interviews. Trained patient-researchers (n = 6), women who had previously experienced a perinatal mental health problem, were trained as research team members and facilitated the interviews alongside a research assistant. All interviews were recorded and transcribed verbatim. Data was analyzed with the use of Nvivo12. Thematic network analysis was used to analyze the data.ResultsThrough the in-depth patient engaged qualitative interviews this study uncovered several specific motivators and behaviors related to perinatal depression screening. Using directed content analysis, several themes within a COM-B frame emerged and could be reduced to themes and further divided into two different stages: the depression screening stage and the post-screening stage.ConclusionsThe results of this qualitative study provide information for health care providers to improve, adjust, and assess the process of conducting perinatal depression screening among women. The data also provide information for health care facilities to identify a better screening tool and develop and measure their screening process. These findings are essential to design comprehensive patient-centered screening protocols given the increase in state and federal policies urging universal depression screening.

The role of maternal and child healthcare providers in identifying and supporting perinatal mental health disorders

“…Several studies [ 7 , 9 , 10 , 13 , 21 ] describe mothers’ preferences for engaging in face-to-face dialogues about PND with their provider, and believed the PND screening process would be more effective if providers reviewed the purpose of the screening tools, explained test scores, and provided timely follow-up referrals. Inquiring about a mother’s mood and her social environment is a valuable screening approach as it provides information on her emotional state and can alert the provider to the risk for PND [ 22 ], exceeding the benefits of a checklist alone [ 23 ].…”

“…According to data reported in the Pregnancy Risk Assessment Monitoring System (PRAMS) survey in 2018, based on patients’ self-reports, one in eight women in the postpartum period and one in five women in the antenatal period were not asked about depression during visits, suggesting an inadequate rate of provider screening with a higher prevalence of provider screening during postpartum compared to antenatal visits [ 1 ]. Similarly, other studies describe less than optimal rates of provider PND screening [ 7 , 8 ], or when screening did occur, the purpose of the screening tool and/or screening results were not disclosed, nor was follow-up provided, causing mothers to perceive the screening as ineffective [ 9 , 10 ]. Although screening for depression and other mental health symptoms is recommended during the entire perinatal period [ 11 ], data from studies [ 7 – 10 ], reflect overall lower than expected rates and/or inadequate PND screening.…”

“…Similarly, other studies describe less than optimal rates of provider PND screening [ 7 , 8 ], or when screening did occur, the purpose of the screening tool and/or screening results were not disclosed, nor was follow-up provided, causing mothers to perceive the screening as ineffective [ 9 , 10 ]. Although screening for depression and other mental health symptoms is recommended during the entire perinatal period [ 11 ], data from studies [ 7 – 10 ], reflect overall lower than expected rates and/or inadequate PND screening. Moreover, screening methods used to detect AND and PPD within various clinical settings often lack standardization, and symptoms associated with depression are often discounted as normal changes associated with pregnancy and the period following the delivery of the infant [ 12 ].…”

“…Given these factors, it is important to explore the role of obstetricians and other providers of maternal and child healthcare in detecting, screening, and referring perinatal women identified as being depressed, anxious, or exhibiting symptoms of mental health disorders. Additionally, enhancing patient-provider conversations about PND and assessing social support networks along with other factors that contribute to PND may mitigate patient disconnections with providers and thereby improve perinatal mental health screening overall [ 10 ].…”