Screening for postpartum depression: Most caught at 2 months and teen fathers nowhere to be found

By Nestor Lopez-Duran PhD

I was reading through the last issue of the journal Pediatrics and encountered a study that made me think about a previous post I wrote concerning the effects of Fathers postpartum depression. This new study explored the increasing practice by pediatricians and family doctors of screening for postpartum depression during well-baby checkups.

This new study was conducted by a group of researchers at the University of Colorado at Denver.  The authors examined data from the Colorado Adolescent Maternity Program. This program was designed to provide care to 12 to 21-year-old mothers mostly from low income, under-served backgrounds.  The authors wanted to explore the prevalence and incidence of parental depression and the effectiveness of an electronic screening reminder system for clinicians. Specifically, during a well baby visit, an electronic cue appeared on the patients electronic record requesting the clinician to administer a postpartum depression screening instrument.

The results:

  1. The system provided 413 reminders and clinicians appropriately administered the depression screening 99% of the time.
  2. 20% of the mothers screened positive of depression and were referred for further evaluation
  3. The prevalence of positive screens was between 10 to 19% during a 2-week, 2-month, 4-month, and 6-month visit. Specifically, the prevalence was: for 2 week= 17%; 2-month= 16.5%; 4-month= 10%; and 6-month = 18.5%; Prevalence refers to the total number of current positive cases.  For example, at the 2-month visit, 16.5% of the mothers screened positive. However, at the 4-month visit only 10% of the mothers screened positive. There was no time-related trend in the prevalence of depression.
  4. The incidence however varied significantly with time. The incidence was about 17% during the 2-week and 2-month visit and then only 2.9% and 1.9% during the 4- and 6- month visit, respectively.  Incidence refers to the rate of new cases. Thus the risk of testing positive for postpartum depression for the first time during the 4-month and 6-month visit was very low. In fact, the authors reported that only 2 cases of depression would have been missed if the screening had taken place only during the 2-month visit.

Two thoughts:  Other studies have shown a 20% prevalence rate of postpartum depression, so these numbers are relatively in line with previous research. But I was actually surprised that the prevalence wasnt higher.  Remember these are adolescent mothers mostly with low SES and likely limited resources. I was expecting that these mothers were more at-risk not only because of their background, but also because depression rates increase dramatically in adolescence.  In fact, a previous investigation of postpartum depression among adolescent mothers found the prevalence rate much closer to 30% (see Birkeland et al., 2005 Adolescent Motherhood and Postpartum Depression. DOI 10.1207/s15374424jccp3402_8). So it is possible that these low rates reflect the effectiveness of the Colorado Adolescent Maternity Program. This is promising as it suggests that social programs that provide health care access to adolescent mothers may reduce the risk of developing postpartum depression in this at-risk population.

My second thought was what about the fathers? In my previous postpartum depression post I discussed the often neglected finding that fathers also experience postpartum depression at the same rate as mothers, and that it seems that fathers depression may have an even greater impact on the babys development.   Im not blaming the researchers.  The absence of fathers from the study reflected the fact that only in a small number of cases the mother was not the person who brought the baby for the check up. So this reflects our social tendency of fathers to be absent from these aspects of the parenting process. The problem goes beyond the implications for equality and gender roles.  The absence of fathers during the well baby visits also means that these fathers are not being screened for depression, greatly limiting our ability to identify and address this potential public health problem.

The Reference: Sheeder, J., Kabir, K., & Stafford, B. (2009). Screening for Postpartum Depression at Well-Child Visits: Is Once Enough During the First 6 Months of Life? PEDIATRICS, 123 (6) DOI: 10.1542/peds.2008-1160