Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice

Background: Postpartum depression occurs in 10% to 20% of women who have recently given birth, but fewer than half of cases are recognized. The purpose of this review is to discuss the potential benefit of mass screening for improving postpartum depression recognition and outcomes. Methods: A review of the literature was conducted by searching MEDLINE, using the key words “depression,” “postpartum depression,” and “mass screening.” The Cochrane database was also searched for reviews on depression and postpartum depression. Results: Opportunities for routine postpartum depression screening include mothers’ postpartum office visits and their infants’ well-child visits. Although several depression screens have been used in postpartum women, additional studies using large representative samples are needed to identify the ideal screening tool. Depression screening plus “high-risk” feedback to providers improves the recognition of depression. However, for screening to positively impact clinical outcomes, it needs to be combined with systems-based enhanced depression care that provides accurate diagnoses, strong collaborative relationships between primary care and mental health providers, and longitudinal case management, to assure appropriate treatment and follow-up. Conclusions: Postpartum depression screening improves recognition of the disorder, but improvement in clinical outcomes requires enhanced care that ensures adequate treatment and follow-up.

[1]  R. Newcombe,et al.  'Maternity blues' and hormone levels in saliva. , 1984, Journal of affective disorders.

[2]  S. Wolkind Mothers' depression and their children's attendance at medical facilities. , 1985, Journal of psychosomatic research.

[3]  T. Field,et al.  Infants of depressed mothers show "depressed" behavior even with nondepressed adults. , 1988, Child development.

[4]  A. Frodi,et al.  Maternal correlates of infant temperament ratings and of infant-mother attachment: a longitudinal study , 1989 .

[5]  L. Murray,et al.  The effects of postnatal depression on the infant. , 1989, Bailliere's clinical obstetrics and gynaecology.

[6]  E. J. Wright,et al.  Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. , 1990, Journal of abnormal psychology.

[7]  S. McLachlan,et al.  Geographical distribution of subclinical autoimmune thyroid disease in Britain: a study using highly sensitive direct assays for autoantibodies to thyroglobulin and thyroid peroxidase. , 1990, Acta endocrinologica.

[8]  V. Pop,et al.  Postpartum thyroid dysfunction and depression in an unselected population. , 1991, The New England journal of medicine.

[9]  J. Studd,et al.  Treatment of severe postnatal depression with oestradiol skin patches , 1991, The Lancet.

[10]  D. Gath,et al.  The Relationship between Post-natal Depression and Mother–Child Interaction , 1991, British Journal of Psychiatry.

[11]  E. J. Wright,et al.  Prospective study of postpartum blues. Biologic and psychosocial factors. , 1991, Archives of general psychiatry.

[12]  L Murray,et al.  The impact of postnatal depression on infant development. , 1992, Journal of child psychology and psychiatry, and allied disciplines.

[13]  R. Newcombe,et al.  Association between postpartum thyroid dysfunction and thyroid antibodies and depression. , 1992, BMJ.

[14]  J. Cox,et al.  A Controlled Study of the Onset, Duration and Prevalence of Postnatal Depression , 1993, British Journal of Psychiatry.

[15]  B. Cramer Are postpartum depressions a mother-infant relationship disorder? , 1993 .

[16]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[17]  S. Buzwell,et al.  Avoidant attachment as a risk factor for health. , 1994, The British journal of medical psychology.

[18]  Morris Green,et al.  Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. , 1994 .

[19]  B. Harris Biological and Hormonal Aspects of Postpartum Depressed Mood , 1994, British Journal of Psychiatry.

[20]  P. Zelkowitz,et al.  Screening for Post-Partum Depression in a Community Sample , 1995, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[21]  P. Cooper,et al.  Course and Recurrence of Postnatal Depression , 1995, British Journal of Psychiatry.

[22]  Tiffany M Field,et al.  Infants of depressed mothers , 1992, Development and Psychopathology.

[23]  T. Field,et al.  Newborns of depressed mothers , 1995 .

[24]  P. Cooper,et al.  The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. , 1996, Child development.

[25]  P J Cooper,et al.  EDITORIAL: Postpartum depression and child development , 1997, Psychological Medicine.

[26]  C. Hwang,et al.  Screening for postnatal depression in a population‐based Swedish sample , 1997, Acta psychiatrica Scandinavica.

[27]  E. Tronick,et al.  Depressed mothers and infants: Failure to form dyadic states of consciousness. , 1997 .

[28]  P. Cooper,et al.  The role of infant and maternal factors in postpartum depression, mother–infant interactions, and infant outcome. , 1997 .

[29]  T. Field Maternal depression effects on infants and early interventions. , 1998, Preventive medicine.

[30]  I. Jones,et al.  Postnatal depression in the community. , 1998, The British journal of general practice : the journal of the Royal College of General Practitioners.

[31]  C T Beck,et al.  The effects of postpartum depression on child development: a meta-analysis. , 1998, Archives of psychiatric nursing.

[32]  M. Steiner Perinatal mood disorders: position paper. , 1998, Psychopharmacology bulletin.

[33]  B. Yawn,et al.  Incidence of postpartum depression in Olmsted County, Minnesota. A population-based, retrospective study. , 1999, The Journal of reproductive medicine.

[34]  T. Therneau,et al.  Population-based screening for postpartum depression. , 1999, Obstetrics and gynecology.

[35]  M. Klinkman Strategies for effective management of depression in primary care. Based on a presentation by Michael S. Klinkman, MD. , 1999, The American journal of managed care.

[36]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[37]  A. Stein,et al.  The socioemotional development of 5-year-old children of postnatally depressed mothers. , 1999, Journal of child psychology and psychiatry, and allied disciplines.

[38]  A. Dietrich,et al.  Primary care physicians' approach to depressive disorders. Effects of physician specialty and practice structure. , 1999, Archives of family medicine.

[39]  S. Galvin,et al.  Postpartum depression: a comparison of screening and routine clinical evaluation. , 2000, American journal of obstetrics and gynecology.

[40]  L. Bauman,et al.  Do pediatricians recognize mothers with depressive symptoms? , 2000, Pediatrics.

[41]  D. Rubinow,et al.  Effects of gonadal steroids in women with a history of postpartum depression. , 2000, The American journal of psychiatry.

[42]  S. Pawlby,et al.  Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. , 2001, Journal of child psychology and psychiatry, and allied disciplines.

[43]  Deborah J. Weatherston Infant Mental Health , 2001 .

[44]  C T Beck,et al.  Predictors of Postpartum Depression: An Update , 2001, Nursing research.

[45]  Gro Harlem Brundtland,et al.  Mental Health: New Understanding, New Hope , 2001 .

[46]  B. Kelly St John's wort for depression: what's the evidence? , 2001, Hospital medicine.

[47]  J. Sayers The world health report 2001 - Mental health: new understanding, new hope , 2001 .

[48]  B. Yawn,et al.  Routine screening for postpartum depression. , 2001, The Journal of family practice.

[49]  R. Platt,et al.  Infant sucking ability, non-organic failure to thrive, maternal characteristics, and feeding practices: a prospective cohort study. , 2002, Developmental medicine and child neurology.

[50]  Screening for depression: recommendations and rationale. , 2002 .

[51]  Kathleen N Lohr,et al.  Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force , 2002, Annals of Internal Medicine.

[52]  Kelly J Kelleher,et al.  Primary care pediatricians' roles and perceived responsibilities in the identification and management of maternal depression. , 2002, Pediatrics.

[53]  Alfred O. Berg,et al.  Screening for Depression: Recommendations and Rationale , 2002, Annals of Internal Medicine.

[54]  D. Gjerdingen The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. , 2003, The Journal of the American Board of Family Practice.

[55]  A. Skrondal,et al.  A comparison of anxiety and depressive symptomatology in postpartum and non-postpartum mothers , 2003, Social Psychiatry and Psychiatric Epidemiology.

[56]  M. Freda,et al.  Screening for postpartum depression in an inner-city population. , 2003, American journal of obstetrics and gynecology.

[57]  W. Katon,et al.  Depression Screening Attitudes and Practices Among Obstetrician–Gynecologists , 2003, Obstetrics and gynecology.

[58]  D. Stewart,et al.  The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature , 2003, Archives of Women’s Mental Health.

[59]  M. Austin,et al.  Antenatal screening for postnatal depression: a systematic review , 2003, Acta psychiatrica Scandinavica.

[60]  Wayne Katon,et al.  Improving Services for Women with Depression in Primary Care Settings , 2003 .

[61]  Harold Alan Pincus,et al.  Addressing depression in obstetrics/gynecology practice. , 2003, General hospital psychiatry.

[62]  R. Spitzer,et al.  Validity of a Two-Item Depression Screener , 2003 .

[63]  D. Nease,et al.  Depression screening: a practical strategy. , 2003, The Journal of family practice.

[64]  R. Phillips,et al.  Family physicians increase provision of well-infant care despite decline in prenatal services. , 2003, American family physician.

[65]  R. Spitzer,et al.  The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener , 2003, Medical care.

[66]  M. Righetti-Veltema,et al.  Impact of postpartum depressive symptoms on mother and her 18-month-old infant , 2003, European Child & Adolescent Psychiatry.

[67]  Young-Joo Park,et al.  [The predictors of postpartum depression]. , 2004, Taehan Kanho Hakhoe chi.

[68]  C. Wiley,et al.  Pediatricians’ views of postpartum depression: A self-administered survey , 2004, Archives of Women’s Mental Health.

[69]  R. Kumar,et al.  Postnatal mental illness: a transcultural perspective , 1994, Social Psychiatry and Psychiatric Epidemiology.

[70]  M. Currie,et al.  The pediatrician's role in recognizing and intervening in postpartum depression. , 2004, Pediatric clinics of North America.

[71]  M. Mercer,et al.  Will mothers discuss parenting stress and depressive symptoms with their child's pediatrician? , 2004, Pediatrics.

[72]  Neal Halfon,et al.  Measuring the quality of preventive and developmental services for young children: national estimates and patterns of clinicians' performance. , 2004, Pediatrics.

[73]  L. Chaudron,et al.  Detection of postpartum depressive symptoms by screening at well-child visits. , 2004, Pediatrics.

[74]  M. Weissman,et al.  Depressed mothers coming to primary care: maternal reports of problems with their children. , 2004, Journal of affective disorders.

[75]  D. Ugarriza Group therapy and its barriers for women suffering from postpartum depression. , 2004, Archives of psychiatric nursing.

[76]  W. Robinson,et al.  Depression treatment in primary care. , 2005, The Journal of the American Board of Family Practice.

[77]  T. Sheldon,et al.  Screening and case finding instruments for depression. , 2005, The Cochrane database of systematic reviews.

[78]  H. Le,et al.  Review of screening instruments for postpartum depression , 2005, Archives of Women’s Mental Health.

[79]  C. Chin,et al.  Impact of postpartum depression on the mother-infant couple. , 2005, Birth.

[80]  N Gavin,et al.  Perinatal Depression : Prevalence , Screening Accuracy , and Screening Outcomes Summary , 2005 .

[81]  D. Seehusen,et al.  Are family physicians appropriately screening for postpartum depression? , 2005, The Journal of the American Board of Family Practice.

[82]  R. Wright,et al.  Postpartum depression assessments at well-baby visits: screening feasibility, prevalence, and risk factors. , 2005, Journal of women's health.

[83]  J. Brandt,et al.  Detection and diagnosis , 2005 .

[84]  J. Milgrom,et al.  A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women , 2006, BMC public health.

[85]  D. Ellwood,et al.  Acceptability of routine screening for perinatal depression. , 2006, Journal of affective disorders.

[86]  M. Weissman,et al.  Remissions in Maternal Depression and Child Psychopathology: A STAR*D-Child Report , 2006, JAMA.

[87]  I. Cardone,et al.  Universal Perinatal Depression Screening in an Academic Medical Center , 2006, Obstetrics and gynecology.

[88]  P. D. M. Faap Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents , 2007 .

[89]  P. Nutting,et al.  Barriers to initiating depression treatment in primary care practice , 2002, Journal of General Internal Medicine.

[90]  T. Markestad,et al.  A population-based retrospective study , 2009 .