An article by Ms. Melissa Goldin Evans, a student in the LSU New Orleans Health School of Public Health (SPH) doctoral program of Community Health Sciences (CHS), was published in the September issue of Women’s Health Issues.
Entitled “Examining the Screening Practices of Physicians for Postpartum Depression: Implications for Improving Health Outcomes”, the literature review examines 11 research studies of pediatricians, obstetric/gynecologists (OB/GYN) and family practitioners’ screening practices for postpartum depression (PPD). Those 11 studies were narrowed down from an initial list of 169 studies by selecting only those studies that identified screening attitudes and activities in the United States by physicians in those three specialties.
As lead author on this article, Mrs. Goldin Evans was joined in conducting the literature review of the 11 studies by two SPH faculty members (Dr. Stephen Phillippi, and Dr. Rebekah Gee) from the CHS and Health Policy and Systems Management programs.
Although a majority of the 11 studies’ 3,261 physicians felt a responsibility to identify PPD, a minority of these physicians were “confident in their skills to recognize PPD.” Most physicians “were open to improving their PPD detection skills”; however, pediatricians were the least inclined to utilize screening tools. The article sites several reasons for limited screening practices and reluctance to uniformly screen for PPD. These include “inadequate mental health services, liability issues, financial disincentives, perceived treatment as ineffective, and (perceptions that) the mother did not want to discuss PPD symptoms with them.”
The prevalence of PPD has not been effectively calculated due to poor screening and diagnosis data. However, the medical community generally estimates that 10 to 20 percent of women have “depressive symptoms after childbirth.” This would result in approximately 400,000 annual childbirths to depressed mother. This is especially true among “low-income, African American, Hispanic, first-time and teenage mothers and/or (mothers who have) experienced a high-risk birth,” those with a personal or family history of depression, substance abuse and those with a poor social support system.
Since the postpartum period involves increased utilization of physician services (in all three specialties) this would present the physicians with ideal opportunities to screen for PPD. Considering the long-term negative effects of PPD on children, pediatricians acknowledge the value of early screening. However, they were “least likely to do a symptom review” for PPD among the mothers of their patients.
Much of “this paradox between beliefs and behavior” can be attributed to lack of knowledge and skills regarding screening. Therefore, the article recommends (as does the American College of Obstetrics and Gynecology [ACOG]) PPD screening as part of “the standard of care for postpartum patients and at well-child pediatric visits, particularly at the first visit when the prevalence of maternal depression is the highest.”
Such changes in practice would require cultural shifts and support of healthcare policies, systems and organizations (i.e., hospitals and clinics). Given the compelling evidence for implementing screenings, the article recognizes that clinical protocols must be developed and referral standards established to follow up on necessary treatment. Continuing medical education and training during residency should target the necessity of PPD screenings and more professional organizations (such as ACOG) “should endorse universal screening.” State and federal governments are supporting screening and “treatment guidelines regarding PPD. “The Affordable Care Act requires insurers to cover costs of PPD screening” and has established “grants to offset some of the costs.”