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Practice-wide approach found effective against postpartum depression

Postpartum depression improved after primary care-based screening, diagnosis and management, compared with usual care, according to study results. Researchers said the practice-wide approach could be implemented widely and with modest resources.

“Postpartum depression is common and deserves systemic screening, identification and follow up,” study researcher Barbara P. Yawn, MD, MSc, FAAFP, director of research at the Olmsted Medical Center in Minnesota, told Healio.com. “Family medicine practices can provide that care and patients should ask for it.”

Yawn and colleagues enrolled 2,343 women aged 18 years and older in 28 practices, which were randomly assigned to either usual care (n=14) or practice-wide intervention (n=14), referred to as Translating Research into Practice for Postpartum Depression (TRIPPD).

Intervention consisted of training staff members for a multistep postpartum screening and diagnosis process using the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9). PHQ-9 screening and physician evaluations were used in place of the DSM-IV Structured Clinical Interview. Each intervention site was provided a set of tools to help facilitate diagnosis, follow-up and management of postpartum depression. The tools included an outline for postpartum depression visits and a written format for follow-up telephone calls that focused on medication initiation, adherence and side effects.  Intervention sites also had continuous access to PHQ-9 scores, while the control sites did not.

Control sites practiced informed consent and developed site-specific implementation plans, while intervention sites spent additional training on postpartum depression screening and diagnosis and follow-up.

Data on depression, dyad satisfaction and maternal anxiety were self-reported.

Overall, 34.5% of participants had elevated screening scores indicative of depression, with comparable rates between the intervention and control sites (29.5% vs. 25.8%, respectively). Among participants with elevated postpartum depression screening scores, those in the intervention sites were more likely to receive a diagnosis (P=.0006) and therapy for postpartum depression (P=.002), and also had lower depressive symptoms at 6 (P=.07) and 12 months (P=.001) postpartum.

“TRIPPD is the first large US-based effectiveness study of screening and follow-up care for postpartum depression that has shown any improvement in maternal outcomes at 12 months,” the researchers wrote. “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.”

The researchers added that the study results warrant further consideration of programs similar to TRPPD based in family practices that have minimal requirements for referrals to outside mental health services.

Disclosure: The researchers received funding support from the Agency for HealthCare Research and Quality.