Two Approaches to Maternal Depression Screening During Well Child Visits

Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
Journal of Developmental & Behavioral Pediatrics (Impact Factor: 2.13). 07/2005; 26(3):169-76. DOI: 10.1097/00004703-200506000-00002
Source: PubMed


The US Preventive Services Task Force (USPSTF) has recommended depression screening for adults. Screening mothers has special importance to pediatricians because of the impact of maternal depression on children. The two screening questions endorsed by the USPSTF may allow pediatricians to screen mothers during routine well child care. This study explores the feasibility and yield of interview- and paper-based pediatric screening for maternal depression during well child visits. A structured interview script was developed to inquire about maternal depression. It included the two-question screen and required less than 1 minute to administer. An alternative paper-based screen asked the two questions after a brief written introduction providing the rationale. Four community pediatric practices in New Hampshire and Maine were trained in both screening approaches and developed plans on how to respond to positive screens (either question positive). The 11 providers at these sites tested the two approaches on two different series of mothers at well child visits. The pediatricians also reported barriers to the screening inquiries, maternal responses, and subsequent clinician actions and referrals. The pediatricians screened 250 mothers via the scripted interview. In a second trial, 223 women had paper-based depression screening. Yields from the paper-based screen were 22.9% versus 5.7% for the interview-based screener. Pediatricians also took on the new role of discussion of possible depression in about two thirds of cases. Subsequently, 7.6% of all women with paper-based screening were referred to mental health versus 1.6% with the interview-based screening. With the interview, mothers of children younger than 1 year of age were less likely to screen positive than those with older children (1.9% vs. 8.5%, p = .04). With the paper-based screener, no age differences in positive screen rates occurred. While both approaches to screening were feasible in primary care, the yield from the two different approaches differed substantially. This finding deserves exploration in future studies. With either of these screening approaches, pediatricians could enhance their detection of mothers at risk of depression. The outcomes of pediatrician screening and the best approach to follow-up care still need to be determined.

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    • "We should note that we utilized an interview format, which could have resulted in fewer positive screens, as prior studies have shown that the written format produces more positive screening results (Olson et al., 2005). Our study was focused on low-income preschool-age children and their mothers. "
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    ABSTRACT: Research Findings: The purpose of this study was to examine the relationship between low-level depressive symptoms in mothers and teacher-reported child behavioral outcomes. Participants included 442 low-income mothers of preschool-age children who were screened for maternal depression by their child's preschool teacher. Teacher reports of child behavior problems were collected on a random sample of the children (n = 264). Of mothers screened for depression, 16.7% reported low-level depressive symptoms (below the cutoff on the screener indicating clinically elevated symptoms). Analyses revealed that children of mothers with low-level depressive symptoms had significantly greater problems with externalizing behavior compared to children of mothers with no depressive symptoms. Practice or Policy: Results suggest that children whose mothers experience even low-level depressive symptoms are at risk for problems with behavior, pointing to the need for screening and interventions to address maternal depression at all levels of severity. Early childhood education providers are in an excellent position to support families impacted by symptoms of maternal depression through screening and education, supportive daily interactions, and referrals for services if needed. Teachers can also provide direct support for high-risk children's social and emotional skill development through the provision of sensitive, nurturing care.
    Early Education and Development 11/2014; 26(2):230-244. DOI:10.1080/10409289.2015.979725 · 0.84 Impact Factor
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    • ". e . , patient education ) is helpful in talking to mothers about depression and facili - tating referrals ( Olson et al . , 2005 ) ; in fact , one study showed that discussions between doctors and mothers about depression encouraged about 40% of mothers not already in treatment to accept referral for further mental health assess - ment or care ( Olson et al . , 2005 ) ."
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    ABSTRACT: Maternal depression is a major public health concern in the United States affecting mothers, children, and families. Many mothers experience depression, and exposure to maternal depression can put children at increased risk for psychopathology and poor psychosocial development. Early recognition of maternal depression is a critical step in promoting healthy development and preventing adverse outcomes in children and families. In this review, we examine some of the major barriers that mothers face in seeking help for depression; discuss optimal settings in which to implement maternal depression screening; review available depression screening tools for identifying mothers in need of care; discuss steps providers can take after screening; examine barriers to screening; and present information about promising initiatives developed to address these barriers.
    Families Systems & Health 03/2012; 30(1):1-18. DOI:10.1037/a0027602 · 1.13 Impact Factor
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    • "Inclusion criteria consisted of primary studies which examined the brief case-finding questions in a postnatal population, where the accuracy of these questions was compared to a gold standard or 'reference' standard test. A total of six studies which used the case-finding questions for postnatal depression was identified and selected as the reference set [20-25]. "
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    ABSTRACT: Challenges exist when searching for diagnostic test accuracy (DTA) studies that include the design of DTA search strategies and selection of appropriate filters. This paper compares the performance of three MEDLINE search strategies for psychometric diagnostic test accuracy (DTA) studies in postnatal depression. A reference set of six relevant studies was derived from a forward citation search via Web of Knowledge. The performance of the 'target condition and index test' method recommended by the Cochrane DTA Group was compared to two alternative strategies which included methodological filters. Outcome measures were total citations retrieved, sensitivity, precision and associated 95% confidence intervals (95%CI). The Cochrane recommended strategy and one of the filtered search strategies were equivalent in performance and both retrieved a total of 105 citations, sensitivity was 100% (95% CI 61%, 100%) and precision was 5.2% (2.6%, 11.9%). The second filtered search retrieved a total of 31 citations, sensitivity was 66.6% (30%, 90%) and precision was 12.9% (5.1%, 28.6%). This search missed the DTA study with most relevance to the DTA review. The Cochrane recommended search strategy, 'target condition and index test', method was pragmatic and sensitive. It was considered the optimum method for retrieval of relevant studies for a psychometric DTA review (in this case for postnatal depression). Potential limitations of using filtered searches during a psychometric mental health DTA review should be considered.
    Systematic Reviews 02/2012; 1(1):9. DOI:10.1186/2046-4053-1-9
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