She Screened Positive for Depression at the First Prenatal Visit, What Really Happens Next?
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She Screened Positive for Depression at the First Prenatal Visit, What Really Happens Next? Ellen J. Tourtelot1 · Jasmine R. Davis2,4 · Nicole Trabold3 · Devyani K. Shah2,5 · Ellen Poleshuck1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The aim of this mixed-methods study was to evaluate how providers in a busy urban practice with universal depression screening and co-located behavioral health services responded to positive screens and to explore patient expectations and attitudes towards positive screens. Semi-structured interviews of 20 pregnant women were conducted within 10 days of a positive depression screen or endorsement of suicidal ideation on the Edinburgh Perinatal Depression Scale and health record documentation was reviewed. Qualitative data were entered into a meta-matrix and cross-case analysis was used to reduce the data and determine prominent patterns and themes. Most participants reported discussing their mood with their provider, appreciated the discussion and were satisfied with the plan. Most had documentation of a discussion by their provider. Only 4 of 9 participants who endorsed thoughts of self-harm had documentation of a discussion regarding their response. While nearly all women were recommended for psychotherapy, most did not receive it. Participants expected follow-up but few had discussion of mood documented at the second prenatal visit, independent of seeing the same provider. Co-located behavioral health did not guarantee that services were utilized. There is a need to incorporate tested integrated care approaches to improve assessments and linkage to effective depression treatment. Keywords Perinatal depression · Positive depression screen · Suicide assessment · Depression treatment engagement · Integrated care
Introduction Perinatal depression, defined as the occurrence of a major or minor depressive episode during pregnancy or up to 1 year after childbirth (The ACOG Committee Opinion No.630), is a common phenomenon, affecting one in seven women * Ellen J. Tourtelot [email protected] 1
Department of Obstetrics and Gynecology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14620, USA
2
Department of Psychiatry, University of Rochester, Rochester, NY, USA
3
Department of Behavioral Health Sciences, Rochester Institute of Technology, College of Health Science and Technology, Rochester, NY, USA
4
Department of Counseling Psychology, University of Denver, Denver, CO, USA
5
Department of Psychiatry, Rutgers University, Newark, NJ, USA
and one in five women with socioeconomic disadvantage (Cook et al., 2010; Scholle et al., 2003). Symptoms of depression (increased or decreased appetite, disturbance in sleep, decreased energy and concentration) can overlap with the common symptoms of pregnancy and can be easily missed by the obstetric provider. Failure to treat depression can have significant consequences for the mother, infant as well as the entire family structure (Infants, Family Are Affected
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