All new moms should be screened for postpartum depression, according to a national study led by a Rochester researcher. Currently, screening a new mother for depression isn’t a routine medical practice, although the disorder is fairly common after the birth of a baby.
“We really try not to screen for things until we know that screening actually makes a difference,” said Dr. Barbara Yawn, lead author of the study and director of research at Olmsted Medical Center in Rochester.
This is the first large U.S. study of screening and follow-up that gives better results for mothers at one year post-birth. “We did decrease their burden of depression symptoms, and this is the first study that’s been able to do that,” Yawn said.
Instead of focusing on new mothers themselves, the study honed in on changing the way health care providers handle postpartum depression at half of 28 medical practices nationwide.
Researchers randomly assigned each small medical clinic to either a standard-care group (without standardized screening and follow-up) or an “intervention group” in which health providers got extra postpartum depression education, screened every patient and followed up to check the new mothers’ mental health.
“We enrolled about 1,500 women and followed them for a year, and we did enroll women from 28 different practices in 20 different states,” Yawn said.
States with participating medical teams included Alabama, Arizona, California, Colorado, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Missouri, Mississippi, Montana, Oklahoma, Pennsylvania, Rhode Island, Texas, Utah, Vermont, Virginia and Wisconsin.
“Not only did screening increase the number of women with a diagnosis of postpartum depression, it also improved the outcomes in those women whose postpartum depression was diagnosed,” according to the article, published in the July/August issue of the Annals of Family Medicine.
Yawn said the study shows that small clinics that care for new mothers should routinely screen for postpartum depression, diagnose and follow-up onsite to avoid referring women to mental-health appointments that are rarely kept.
“This approach could be implemented widely with modest resources,” the study concludes.
“This is how most of us are trying to change health care now, is by helping practices implement systems that make it easy to ‘do the right thing,’ so to speak,” Yawn said, “and, in this case, it was not only to screen but to make a diagnosis, and then initiate care — and follow-up.”
Yawn said potential study criticisms include lack of psychiatrist-confirmed diagnoses, but she said there aren’t enough psychiatrists and psychologists to do this anyway.
“This is patterned after what would happen in the real world,” Yawn said.
Patients didn’t completely become free of symptoms. However, Yawn added that many women in the control group were not getting diagnosed or treated for postpartum depression at all. In other words, imperfect mental health treatment is better than none.
“We know that our program increased the identification, increased the diagnosis, increased the follow-up,” Yawn said.
The study is part of increasing awareness of postpartum depression and comes on the heels of new evidence-based clinical practice guidelines to help perinatal nurses screen new mothers before they are discharged to home.
Source: Annals of Family Medicine