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Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative

Dr. Yonkers, Ms. Howell, Ms. Shao, and Dr. Rosenheck are affiliated with the Department of Psychiatry and Dr. Smith and Dr. Lin are with the Department of Epidemiology, Yale School of Medicine, 142 Temple St., Suite 301, New Haven, CT 06510 (e-mail: kimberly.yonkers{at}yale.edu).

OBJECTIVE: To address problems with low rates of detection and treatment of depression of pregnant and postpartum women, many advocate depression screening in obstetrical settings. This study evaluated the Healthy Start depression initiative to assess whether it resulted in diminished rates of depressive symptoms and increased rates of detection, referral, and treatment among pregnant and postpartum women. METHODS: Three cohorts were used to examine the program impact: a pre-Healthy Start depression initiative cohort, a post-Healthy Start depression initiative cohort that was enrolled in New Haven Healthy Start, and a post-Healthy Start depression initiative cohort not enrolled in the New Haven program. Participants included 1,336 pregnant and postpartum women receiving obstetrical care at publicly funded health care clinics. Measures included the Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire; the PTSD Symptom Scale; a five-item modification of the Conflict Tactics Scale; and questions regarding alcohol, illicit substances, and general medical and obstetrical history. RESULTS: The Healthy Start depression initiative changed neither levels of depressive symptoms nor use of depression treatment in unselected populations. The initiative may have decreased the rate of referral for depression in the cohort under study. CONCLUSIONS: Universal screening and support for treatment referral by paraprofessionals did not reduce the overall rates of depressive symptoms of perinatal women who received care at publicly funded obstetrical clinics. Future work on depression screening should consider strategies to engage women who are more severely affected by a depressive disorder in behavioral health treatment.

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