Perinatal depression screening practices in a large health system: identifying current state and assessing opportunities to provide more equitable care

Abbey Sidebottom, Marc Vacquier, Elizabeth LaRusso, Darin Erickson, Rachel Hardeman

Research output: Contribution to journalArticlepeer-review

Abstract

The purpose of this study was to assess the prevalence of prenatal and postpartum depression screening in a large health system and to identify covariates for screening, with a specific focus in understanding disparities in practice. A retrospective cohort of women with deliveries in 2016 was created using electronic health records. Primary outcomes were depression screening during pregnancy and the first 3 months postpartum. Generalized linear mixed models with women nested within clinic were used to determine the effect of maternal and clinical characteristics on depression screening. The sample included 7548 women who received prenatal care at 35 clinics and delivered at 10 hospitals. The postpartum sample included 7059 women who returned within 3 months for a postpartum visit. Of those, 65.1% were screened for depression during pregnancy, and 64.4% were screened postpartum. Clinic site was the strongest predictor of screening, accounting for 23–30% of the variability in screening prevalence. There were no disparities identified with regard to prenatal screening. However, several disparities were identified for postpartum screening. After adjusting for clinic, women who were African American, Asian, and otherwise non-white (Native American, multi-racial) were less likely to be screened postpartum than white women (AOR (CI)’s 0.81 (0.65, 1.01), 0.64 (0.53, 0.77), and 0.44 (0.21, 0.96), respectively). Women insured by Medicaid/Medicare, a proxy for low-income, were less likely to be screened postpartum than women who were privately insured (AOR (CI) 0.78 (0.68, 0.89)). National guidelines support universal depression screening of pregnant and postpartum women. The current study found opportunities for improvement in order to achieve universal screening and to deliver equitable care.

Original languageEnglish (US)
Pages (from-to)133-144
Number of pages12
JournalArchives of Women's Mental Health
Volume24
Issue number1
DOIs
StatePublished - Feb 2021

Bibliographical note

Funding Information:
This study was funded by the Abbott Northwestern Hospital Foundation.

Publisher Copyright:
© 2020, The Author(s).

Keywords

  • Disparities
  • Postpartum depression
  • Prenatal depression
  • Screening

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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