Postnatal Depression Screening

Screening at 2 Months Identifies Most Women With Postpartum Depression

by Caroline Cassels & Désirée Lie
Pediatrics. 2009;123: e982 - e988. Abstract
Medscape Psychiatry & Medical News

June 15, 2009 — Using a well-child visit to screen for postpartum depression 2 months after delivery will catch the majority of women likely to develop the condition within the first 6 postpartum months, new research suggests.

Investigators at the University of Colorado Denver School of Medicine also found that using cues embedded in the electronic medical records of infants 0 to 6 months of age to remind physicians to screen new mothers is an effective method of detecting and referring those at risk.

EPDS (Edinburgh Postpartum Depression Scale) scores indicated that the prevalence of depressive symptoms varied from 17.0% at 2 weeks to 16.5% at 2 months.

Screening Before 2 Months Not Useful

The researchers also found that screening for depression during the first 3 weeks was so unreliable that it could not consistently identify the same mothers as being at risk for depression. This finding, the researchers note, argues against routine, universal postpartum depression screening before 2 months.

After 3 weeks, the prevalence and incidence of positive EPDS scores decreased from 16.5% at 2 months to 10.3% and 5.7% respectively at 4 months.
However, prevalence increased to 18.5% at the 6-month visit and incidence decreased to 1.9%, the investigators report.

The authors note that if women had been screened only at the 2-month postpartum time point, only 2 of the 35 mothers with positive EPDS scores at 6 months would have been missed. Both of those mothers completed the EPDS within 3 weeks after delivery, but neither crossed the referral threshold.

No Optimal Screening Interval Identified

Postpartum depression is the most common medical problem new mothers face and is associated with a wide range of maternal and child health problems. It can develop any time during the first postpartum year, and while pediatric visits have been identified as an ideal setting in which to screen women, there is no evidence to support an optimal screening interval, the authors note.

Clinical Context

All new mothers should be screened periodically for postpartum depression because it is treatable and common and has the potential to cause child health problems. Postpartum depression can occur any time during the first year, and the best screening interval and strategy have not yet been identified. Also, the prevalence and accuracy of screening at different times after delivery are not well reported.

for Study Highlights see article:
http://cme.medscape.com/viewarticle/704382?sssdmh=dm1.486302&src=nldne