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Screening and Treatment After Implementation of a Universal Perinatal Depression Screening Program

Miller, Emily S. MD, MPH; Wisner, Katherine L. MD, MS; Gollan, Jacqueline PhD; Hamade, Sara MD; Gossett, Dana R. MD, MSCI; Grobman, William A. MD, MBA

doi: 10.1097/AOG.0000000000003369
Contents: Psychology: Original Research
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OBJECTIVE: To evaluate whether initiation of an institutional policy of universal perinatal depression screening was associated with sustained increases in frequency in screening and of depression treatment subsequent to a positive screen.

METHODS: This retrospective cohort study included women receiving prenatal care in outpatient offices at a single academic medical center from 2008 to 2015. In 2009, an institutional policy of universal perinatal depression screening was disseminated in which screening twice antenatally and again postpartum were recommended. The frequency of screen completion at each recommended time point was compared between the prepolicy and postpolicy cohorts. A test of trend that assessed the frequency of screening each year after policy initiation was used to assess changes over time. The frequency with which care plans were created for women who screened positive for perinatal depression were compared before and after implementation.

RESULTS: Of the 5,127 women who met inclusion criteria, 4,005 (78%) were in the postpolicy cohort. The frequency of completion of depression screening at the first prenatal visit (0.1% vs 65.5%), in the third trimester (0.0% vs 42.7%), and at the postpartum visit (69.5% vs 90.0%) increased after initiation of the policy (P<.001 for all). The improvement in postpartum depression screening completion persisted after controlling for potential confounders (adjusted odds ratio 5.3, 95% CI 4.4–6.5). After the initial increase in uptake of screening, the frequency of screening at the first and third trimester prenatal visits continued to increase over time (P<.001 for each), although this frequency remained stable for the postpartum visit (P=.29). Women with a positive postpartum depression screen were more likely to have depression treatment recommended or provided by their obstetrician postpolicy (64.7% vs 30.1%, P<.001).

CONCLUSION: Implementation of an institutional policy of universal perinatal depression screening was associated with improvements in perinatal depression screening with concomitant improvements in depression treatment recommendations for women with a positive postpartum depression screen.

Implementation of a policy of universal perinatal depression screening was associated with sustained improvements in perinatal depression screening, with concomitant improvements in depression treatment recommendations.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine and the Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and the Northwestern University Clinical and Translational Sciences Institute, Chicago, Illinois; and the Department of Obstetrics and Gynecology, UCSF School of Medicine, San Francisco, California.

Corresponding author: Emily S. Miller, MD, MPH, Northwestern University, Chicago, IL; email: emily-miller-1@northwestern.edu.

Supported by the Society for Maternal-Fetal Medicine/Lumara Health Policy Award (2016 ESM), Eunice Kennedy Shriver National Institute of Child and Human Development K12 HD050121-09, and the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The funding sources had no role in study design, data collection, analysis or interpretation, writing the report or submitting the article for publication.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the Society for Maternal-Fetal Medicine’s Annual Meeting, January 29–February 3, 2018, Dallas, Texas.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B443.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.