More Important Information on Screening for Postpartum Depression

From the Journal of the American Board of Family Medicine: Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice Authors: Dwenda K. Gjerdingen, MD, MS; Barbara P. Yawn, MD

Good article. Not much new info but emphasizes what we already know and need to reinforce. Here are the main points:

1) Depression screening alone does not greatly impact outcomes.

2) “Depression recognition is enhanced when results of positive screens are communicated to providers, and clinical outcomes seem improved when depression screening and feedback programs are coupled with systems that ensure accurate diagnosis and effective treatment and follow-up.”

3) Screening for PPD can improve rates of detection and treatment

4) Most mothers (more than 80%) were comfortable with the concept of being screened for PPD.

5) The current rate of screening in primary care setting is less than 50% by even the most optimistic estimates

Furthermore, this study points out…

6) Even when clinicians do screen for depression:
“The results are not always used for further documented assessment or treatment. One study reported that only 23% of women with abnormal screening for depression or substance abuse had documentation of further evaluation or treatment, while another study found that 60% of screen-positive women had follow-up depression evaluations and 35% were reportedly treated.” Thus, even when providers routinely screen for PPD with validated instruments such as the Edinburgh, they do not always seem to use that information to guide clinical practice. (Yikes!)

7) This study reminds us that a positive screen should not be interpreted as actually having PPD, as only 50% of those with a positive screen actually have PPD, depending on the test and cutoff score used. This underscores the importance of a good diagnostic evaluation which should always follow screening to confirm diagnosis.

8) And finally, they point out that there are two appropriate settings for routine PPD screening: mothers’ postpartum office visits and their infants’ well-child visits.

J Am Board Fam Med. 2007 ;20(3):280-288
pic: images.inmagine.com

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