Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010

Yawn, Barbara P.; Bertram, Susan; Pace, Wilson D.; Wollan, Peter C.; Dietrich, Allen J.

doi:10.1155/2012/363964

Cited by 39 publications

(47 citation statements)

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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%

“…Although such discussion may be of value, its impact on outcomes is unknown, and to date, studies of referral after an initial or repeated screenings have found limited uptake of mental health services by the women referred from pediatric or obstetrical practices. 5,[32][33][34][35] It is therefore necessary to do studies of screening and repeated screening that actually include outcomes to determine whether assessments of risks or benefits can support evidence-based recommendations for rescreening.The factors associated with new elevation of PHQ-9 scores after a baseline screening score of less than 10 are similar to those associated with elevated scores in the more immediate postpartum period: history of depression, limited education, not being married, and anxiety. 3,4,11,12,20 We were unable to assess obesity, history of interpersonal violence, or social support, which have also been associated with PPD in some populations.…”

mentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

mentioning

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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“…En conjunto con lo señalado, se ha referido que un ideal de maternidad exigente, compartido por las mujeres y su entorno, genera temor a no cumplir con las expectativas y reticencia a aceptar emociones negativas no validadas socialmente [24][25][26] . La importancia atribuida a la comunicación adecuada de la sospecha de DPP es respaldada por investigaciones recientes que sugieren la necesidad de entrenamiento del personal de salud para efectuar un proceso de detección integrado a la práctica clínica, que contemple la psicoeducación y acompañamiento a mujeres con sospecha de DPP 27,28 . La evidencia cualitativa en países desarrollados destaca la relevancia que el personal de salud establezca vínculos positivos para la apertura de problemas emocionales, puntualizando la ventaja que supone la continuidad en los cuidados de la salud materno-infantiles para construir este vínculo 24,25 .…”

Section: Discussionunclassified

Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo

et al. 2015

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“…In a recent review of postpartum depression screening and management programs across settings, both United States and international (from pediatrics, primary care-, and communitybased), only a fraction were shown to improve maternal outcomes (26). This review highlighted multiple systems-level barriers to getting women into treatment including requirements for psychiatric evaluations, often off-site, before treatment is provided (26).…”

mentioning

confidence: 99%

“…This review highlighted multiple systems-level barriers to getting women into treatment including requirements for psychiatric evaluations, often off-site, before treatment is provided (26). To date, much of this work to "bridge the gap" between efficacy and effectiveness has been carried out in obstetrics or community medical settings caring for adults.…”

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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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Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010

Cited by 39 publications

References 50 publications

Repeated Depression Screening During the First Postpartum Year

Repeated Depression Screening During the First Postpartum Year

Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo

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

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