Monday, September 11, 2017

Postpartum Depression Screening During Well-Child Visits May Improve Maternal Mental Health

Screening for postpartum depression in a well-child care setting may be an effective way to reduce maternal depressive symptoms and improve overall maternal mental health and parenting, according to a study in Pediatrics.

“Significantly fewer mothers in the intervention group were depressed at nine months postpartum compared with the care-as-usual group (0.6% vs. 2.5% for major depression),” wrote lead author Angarath I. van der Zee-van den Berg, M.D., of the University of Twente in Enschede, Netherlands and colleagues. Furthermore, these mothers scored significantly better on most maternal secondary outcomes, such as parenting and anxiety symptoms, according to the study.  

“This is a nice study that shows screening at well-child visits is feasible, and when paired with referral and treatment, may be able to reduce the incidence and consequences of maternal depression,” Jennifer Payne, M.D., director of the Women’s Mood Disorders Clinic at Johns Hopkins School of Medicine in Baltimore, told Psychiatric News.

Based on the findings, the researchers suggest that routine screening for postpartum depression in well-child care settings should be “seriously considered.” The practice would fit in well with the recommendation statement on screening for depression in adults by the U.S. Preventive Services Task Force and the 2017 recommendations for preventive pediatric health care released by the American Academy of Pediatrics in March, the study noted.

For the study, mothers visiting Dutch well-child care centers were assigned to either the intervention group (n=1,843) or care-as-usual group (n=1,246). Mothers in the intervention group were asked to complete an Edinburgh Postnatal Depression Scale (EPDS) form assessing depression symptoms before well-child care visits at one, three, and six months postpartum. During the well-child care visits, physicians scored the EPDS and discussed the outcome and any recommendations for follow-up care with the mother. Mothers in the care-as-usual group and their newborns visited the well-child care centers with the same frequency as those in the intervention group, but received no EPDS screening that guided further advice and referral.

Symptoms of depression were assessed at the beginning of the study as well as at nine months postpartum using the Mini International Neuropsychiatric Interview. Maternal anxiety, quality of parenting, health-related quality of life, and more were assessed at 12 months postpartum using the Spielberger State-Trait Anxiety Inventory, the Short Form 12-Item Health Survey, and the Maternal Self-Efficacy in the Nurturing Role questionnaire. 

“One potential flaw of the study, which limits interpretation of the results, is that the lifetime history of major depression in the intervention group was significantly lower compared to the care-as-usual group. It also would have been good to know how many women in each group received diagnoses and psychiatric interventions,” Payne noted. 

For related information, see the Psychiatric News article “Early Postpartum Depression Screenings Not Enough to Identify High-Risk Women.”

(Image: iStock/Filipovic018)


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