Despite growing awareness of postpartum depression (PPD), screening is not yet standard care and evidence that screening produces improved health outcomes remains limited.
To examine mental health treatment rates at 3 and 4 months postpartum for women who were identified with PPD symptoms at 2 to 4 weeks after delivery.
A secondary analysis of data from a mother-infant intervention study for women with PPD symptoms was conducted. Postpartum women were screened for PPD symptoms; women with positive PPD screens were assessed at 2, 3, and 4 months postpartum. Research nurses monitored symptoms and encouraged and assisted women who experienced moderate to severe PPD symptoms to seek evaluation and mental health referral from their primary care providers.
From the screening of a community-based population of 1,215 postpartum women, 122 women identified as having PPD enrolled in the clinical trial and 117 participated in all assessments. At 3 and 4 months postpartum, only 14 women (12%) received psychotherapy and fewer received psychopharmacologic treatment. In comparison to women with low PPD symptoms, significantly more women with high PPD symptoms were in therapy at 3 and 4 months.
The inadequacy of treatment rates among a sample of at-risk women raises grave concern. Possible barriers to referral and treatment include clinician and healthcare system, third-party payment, and personal factors. Evaluating health outcomes from PPD screening and testing approaches designed to increase treatment participation are warranted.
June Andrews Horowitz, PhD, APRN, BC, FAAN, is Professor; and Ann Cousins, PhD cand., APRN, BC, is Doctoral Fellow, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts.
Accepted for publication October 20, 2005.
This study was supported in part by the March of Dimes Birth Defects Foundation (Grant no. 12-FY98-0014) and a Research Initiative Grant from Boston College. The authors thank the contributions of the Baby Talk team and consultants, unit nursing staffs, and administrators of Brigham and Women's Hospital and Brockton Hospital, and the mothers and infants who participated in the study.
Corresponding author: June Andrews Horowitz, PhD, APRN, BC, FAAN, Psychiatric-Mental Health Nursing, School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467-3812 (e-mail: firstname.lastname@example.org).