Postpartum depression can be caught at infant visits

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Screening at a well-child visit 2 months after delivery can identify most women who have postpartum depression, according to a study published in the current issue of Pediatrics.

The results also indicate that placing “cues,” or reminders, in the electronic medical records of infants is an effective means of reminding doctors to screen the new mothers for postpartum depression.

“The biggest finding was that it was feasible to screen for postpartum depression in our busy clinic and that electronic reminders were extremely helpful,” lead author Jeanelle Sheeder, from the University of Colorado Denver School of Medicine, told Reuters Health.

"Second, we found that symptoms of postpartum depression are somewhat transient during the first 3 weeks and that screening at (around 2 months) detected most of the mothers with symptoms.”

The study included 204 mothers and 418 electronic depression-screening cues. The cues reminded the physicians to ask mothers to complete the Edinburgh Postpartum Depression Scale (EPDS). A score of 10 or higher was considered a positive result and, in such cases, the medical record could not be closed until a patient treatment plan or referral had been made.

Clinicians responded to 99 percent of the cues and 98 percent of the time they administered the screening test.

Twenty percent of mothers had an EPDS score of 10 or higher and were all referred for treatment of their depression. As Sheeder mentioned, scores were often unreliable up to 3 weeks postpartum.

The prevalence of depression at 2 months was 16.5 percent and at 6 months, 18.5 percent. The authors note that if the mothers had been screened only once, just two cases would have been missed. Although a resurgence of depressive symptoms occurred at the 6-month visit, it rarely led to a recurrence of depression, they add.

“We hope that future studies will focus on prenatal predictors of postpartum depression,” Sheeder said. Early identification gives physicians more time to prepare at-risk mothers for the possibility of a period of depression after they give birth.

“We are continuing our screening program and are currently conducting studies to examine different models of prenatal and postpartum care that may help our young mothers better handle this common problem,” she added.

SOURCE: Pediatrics, June 2009.

By Anthony J. Brown, MD
NEW YORK (Reuters Health)

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