Evaluating universal education and screening for postpartum depression using population-based data

Abstract

Background: In 2006, New Jersey was the first state to mandate prenatal education and screening at hospital delivery for postpartum depression. We sought to evaluate provision of prenatal education and screening at delivery, estimate the prevalence of postpartum depressive symptoms, and identify venues where additional screening and education could occur.

Methods: For women who delivered live infants during 2009 and 2010 in New Jersey, data on Edinburgh Postnatal Depression Scale scores assessed at hospital delivery and recorded on birth records were linked to survey data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of mothers completed 2-8 months postpartum (n=2,391). The PRAMS survey assesses postpartum depressive symptoms and whether the woman's prenatal care provider discussed the signs and symptoms of perinatal depression with her, used as a proxy for prenatal education on depression.

Results: Two-thirds (67.0%) of women reported that a prenatal care provider discussed depression with them and 89.6% were screened for depression at hospital delivery. Among the 13% of women with depressive symptoms at hospital delivery or later in the postpartum period, over a third were Women, Infants, and Children program (WIC) participants, 13% to 32% had an infant in the neonatal intensive care unit (NICU), over 80% attended the maternal postpartum check-up, and over 88% of their infants attended ≥1 well baby visits.

Conclusions: Prenatal education and screening for depression at hospital delivery is feasible and results in the majority of women being educated and screened. However, missed opportunities for education and screening exist. More information is needed on how to utilize WIC, NICU, and well baby and postpartum encounters to ensure effective education, accurate diagnosis, and treatment for depressed mothers.

FIG. 1.

Linked data, sample sizes, and unweighted percentages from the Pregnancy Risk Assessment Monitoring System (PRAMS) and birth certificate records. EPDS, Edinburgh Postnatal Depression Scale.