A community-based screening initiative to identify mothers at risk for postpartum depression

Abstract

Objectives: To conduct a community-based, postpartum depression (PPD) screening initiative, and recommend PPD screening practices.

Design: Descriptive correlational.

Settings: Two academic medical centers, a university research office, and participants' homes.

Participants: Five thousand one hundred and sixty-nine postpartum women age 14 to 49 years.

Methods: The Agency for Healthcare Research and Quality (AHRQ) framework was implemented by identifying a cohort of mothers and conducting PPD screening followed by diagnostic evaluation of those with positive screens. Mothers in the postpartum period were recruited from two academic medical centers and screened for PPD at 4 to 6 weeks postpartum by telephone or mail using the Edinburgh Postnatal Depression Scale (EPDS). Mothers with EPDS scores ≥10 were invited to participate in the Structured Clinical Interview for DSM IV (SCID) to confirm PPD.

Results: Six hundred and seventy-four (13%) women had EPDS scores ≥10; 185 women with elevated EPDS scores agreed to have a SCID diagnostic interview, and 144 were diagnosed with minor or major depression. A significantly higher percentage of women who self-administered and mailed in the EPDS than women who were screened via telephone had scores ≥10. Elevated PPD scores were not associated with age or parity. Race/ethnicity identification other than White and having less than high school education were associated with higher PPD scores.

Conclusions: The AHRQ framework was effective in guiding a large-scale PPD screening initiative by identifying mothers at risk for PPD. Results support previous findings regarding prevalence, selected risk factors, and continued use of the EPDS with SCID confirmation.

Fig. 1

Screening women for postpartum depression (PPD) EPDS: Edinburgh Postnatal Depression Scale SCID: Structured Clinical Interview for DSM IV