2002 International International Biennial Scientific Meeting

IMPROVED DETECTION OF POSTPARTUM DEPRESSION BY SCREENING AT WELL-CHILD CARE VISITS IN A PEDIATRIC CLINIC

Linda H Chaudron*, Peter G. Szilagyi, Harriet J. Kitzman, and Yeates Conwell

*Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA

Linda_Chaudron@URMC.Rochester.edu

Background: Postpartum depression (PPD) affects 10% to 20% of mothers and can negatively affect infant development and pediatric health care utilization. Pediatricians see mothers during well-child care (WCC) and might improve detection of PPD.

Objectives: 1) Assess feasibility of universal maternal screening for PPD during first year WCC visits. 2) Compare detection of and referral for PPD before and after routine use of the Edinburgh Postnatal Depression Scale (EPDS).

Design/Methods: Setting: Large urban pediatric practice at teaching hospital in Rochester, NY. Design: Before-after study to assess feasibility of screening, detection of PPD, and referrals. Intervention: In November 2000 the pediatric practice instituted universal screening for PPD at WCC visits using the EPDS. Measures: We collected data from 220 infant medical records (110 before and 110 after the use of the EPDS). Measures included demographics, notation of PPD in the chart, and referral for PPD. Feasibility was determined by the percentages of mothers available at WCC to receive the EPDS, those who received it, and those who completed or refused it. Analyses: Univariate analyses of EPDS scores [mean scores and scores consistent with depression (>9)] were conducted. PPD was defined as WCC visit documentation of the mother as depressed, taking psychotropic medications, and/or under care for depression. Before-after comparisons were made for detection of PPD and referrals.

Results: Feasiblility of screening: 73% of charts had at least one EPDS recorded during the postpartum year. 91% of the forms were completed. 9% were incomplete due to refusal. 27% had scores >9. Of those, 63% were documented as depressed in the WCC note. Detection of PPD: Depression documentation increased from 4.5% pre-EPDS, to 11.8% post-EPDS. Referrals increased from 1of 7 (14.3%) to 7 of 25 (28%).

Conclusions: Pediatricians can play an active role in early detection and referral for PPD. Use of the EPDS to screen for PPD is feasible at WCC visits and improves detection and referral rates.