Population-Based Screening for Postpartum Depression

Georgiopoulos, Anna M.; Bryan, Tonya L; Yawn, Barbara P.; Houston, Margaret S.; Rummans, Teresa A.; Therneau, Terry M.

doi:10.1097/00006250-199905000-00004

Cited by 100 publications

(138 citation statements)

References 14 publications

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“…2 statistics were used to assess age trends in other demographic categories such as marital status, income above the poverty level, and completion of a high school education. Demographic factors were examined for association with discordant scores using logistic regression.…”

Section: Discussionmentioning

confidence: 99%

Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to Assess Increased Risk of Depression among Postpartum Women

Yawn

Pace²,

Wollan³

et al. 2009

The Journal of the American Board of Family Medicine

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Objectives:To compare the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) as screening tools for postpartum depression.Methods: This study population included the first 500 women to enroll and return their packets during an ongoing study of postpartum depression.Results: The primary outcome of this study was to find rates of concordance and discordance in the EPDS and PHQ-9 categories of "normal" and "increased risk for major depressive disorder." Overall, 97% of eligible women enrolled and 70% returned the packets that included the EPDS and PHQ-9. Four hundred eighty-one of the first 500 packets had complete data, with elevated EPDS or PHQ-9 scores in 138 and 132 women, respectively. Concordance of the EPDS and PHQ-9 were present in 399 women (83%): 326 (67.8%) had "normal" score on both, and 73 (15.2%) had elevated scores for both. Discordant scores in 82 women included 17 with elevated PHQ-9 scores but normal EPDS scores and 65 with elevated EPDS scores and PHQ-9 scores <10. In multivariate logistic regression modeling, only age >30 and low education level were predictive of discordant scores, using EPDS and PHQ-9 scores of >10 as elevated (odds ratio, 1.9 and P ‫؍‬ .02; and odds ratio, 2.3 and P ‫؍‬ .01, respectively). PHQ-9 scores of 5 to 9 have been referred to as consistent with "mild depressive symptoms" and appropriate for "watchful waiting" and repeat PHQ-9 at follow-up. Using this follow-up approach would require reevaluation of 120 (25%) of the women screened.Conclusions: Postpartum depression screening is feasible in primary care practices, and for most women the EPDS and PHQ-9 scores were concordant. Further work is required to identify reasons for the 17% discordant scores as well as to provide definitive recommendations for PHQ-9 scores of 5 to 9.

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Section: Discussionmentioning

confidence: 99%

Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to Assess Increased Risk of Depression among Postpartum Women

Yawn

Pace²,

Wollan³

et al. 2009

The Journal of the American Board of Family Medicine

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“…44 -46,51 For clinicians who do screen for depression, the results are not always used for further documented assessment or treatment. 44,54,56 One study reported that only 23% of women with abnormal screening for depression or substance abuse had documentation of further evaluation or treatment, 54 while another study found that 60% of screen-positive women had follow-up depression evaluations and 35% were reportedly treated. 44 Therefore, even when providers routinely screen for postpartum depression with validated instruments, they do not always seem to use that information to guide clinical practice.…”

Section: Depression Screening In Postpartum Womenmentioning

confidence: 99%

“…Routine screening for postpartum depression with a validated in-strument, the Edinburgh Postnatal Depression Scale (EPDS), increased the rate of diagnosis of postpartum depression from 3.7% before screening to 10.7% post screening, with 19.8% of women having an abnormal screening test. 44 Treatment rates for postpartum depression also increased after the institution of formal routine screening. 44,60,61 In another study of primarily Caucasian women from the United Kingdom, 17% (30 of 176) had positive EPDS screens (score Ն12), but only 7% were perceived to be depressed by the primary health care team.…”

Section: Postpartum Visitsmentioning

confidence: 99%

Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice

Gjerdingen¹,

Yawn²

2007

The Journal of the American Board of Family Medicine

261

185

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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...

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“…Approximately 75% of the cases of this treatable condition are not identified by professionals (eg. [44,45]) and without screening programs, only 10% of women are treated [46]. This constitutes one of the most important and costly public health problems concerning perinatal women [47].…”

Section: Thirdmentioning

confidence: 99%

“…The increase in recognition, diagnosis, and treatment rates, more-than-doubling the detection rate in comparison with routine practice, in the PPT [44,76,77] and in pregnancy [78,79)]. In fact, there is evidence that if screening is combined with a subsequent intervention it may decrease depressive symptoms in the perinatal period (eg.…”

Section: Eighthmentioning

confidence: 99%

Why should we screen for perinatal depression? Ten reasons to do it

Pereira¹,

Soares²,

Bos³

et al. 2014

IJCNMH

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In this paper we review some of the best available evidence to argue that screening for perinatal depression should be systematically conducted since pregnancy. Our view is organized in ten topics: (1) perinatal depression high prevalence; (2) its potential negative consequences, including maternal, conjugal, foetal, infantile, and child effects; (3) its under-detection and treatment; (4) its stigma; (5) the professionals and women misconceptions related to perinatal depression; (6) the availability of valid and short self-report screening instruments for perinatal depression and (7) their acceptability; (8) the increase in recognition, diagnosis, and treatment rates in comparison with routine practice; (9) the opportunity, given the large number of contacts that women have with health professionals in the perinatal period; and (10) perinatal depression screening potential cost-effectiveness.

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Population-Based Screening for Postpartum Depression

Cited by 100 publications

References 14 publications

Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to Assess Increased Risk of Depression among Postpartum Women

Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to Assess Increased Risk of Depression among Postpartum Women

Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice

Why should we screen for perinatal depression? Ten reasons to do it

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