Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. e982-e988 (doi:10.1542/peds.2008-1160)
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ARTICLE

Screening for Postpartum Depression at Well-Child Visits: Is Once Enough During the First 6 Months of Life?

Jeanelle Sheeder, MSPHa,b, Karolyn Kabir, MDb and Brian Stafford, MD, MPHb,c

a Departments of Obstetrics and Gynecology
b Pediatrics
c Psychiatry, Colorado Adolescent Maternity Program, University of Colorado Denver School of Medicine, Denver, Colorado

OBJECTIVE. Screening for maternal depression is gaining acceptance as a standard component of well-child care. We tested the feasibility of this policy and determined the prevalence and incidence of maternal depression at well-child visits during the first 6 months of life.

METHODS. Providers in an adolescent-oriented maternity program were cued electronically, when they opened the electronic medical records of 0- to 6-month-old infants to conduct well-child visits, to ask the mothers to complete the Edinburgh Postpartum Depression Scale. Incident cases represented mothers who crossed the referral threshold (score of ≥10) after the first screening.

RESULTS. Mothers usually brought their infants to the clinic, and none refused screening. Providers could act on 99% of the 418 screening cues; they administered the Edinburgh Postpartum Depression Scale 98% of the time and always referred mothers with scores of ≥10. Overall, 20% of the mothers scored ≥10. Scores were unstable at ≤3 postpartum weeks ({kappa} = 0.2). Thereafter, the prevalence and incidence of scores of ≥10 decreased from 16.5% at 2 months to 10.3% and 5.7%, respectively, at 4 months. Prevalence increased to 18.5% at the 6-month visit, and incidence decreased to 1.9%. Repeat screening detected only 2 mothers (5.7%) with scores of ≥10.

CONCLUSIONS. Electronic cueing improved compliance with the detection and referral phases of screening for maternal depression at well-child visits. Screening 2 months after delivery detects most mothers who become depressed during the first 6 postpartum months, and screening at the 6-month well-child visit is preferable to screening at the 4-month visit.

Key Words: postpartum depression • health screening • well-child care

Abbreviations: EPDS—Edinburgh Postpartum Depression Scale • CAMP—Colorado Adolescent Maternity Program

Accepted Feb 2, 2009.


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