Depression screening of perinatal women by the Des Moines Healthy Start Project: program description and evaluation

OBJECTIVE: Maternal depression is linked to poor infant and child outcome. In 2001, the U.S. Health Resources and Services Administration required all Healthy Start programs to incorporate maternal-depression screening as part of home visiting services. This article describes the implementation and results of depression screening by the Des Moines Healthy Start Project between 2002 and 2009. The study represents the first longitudinal assessment of the Healthy Start maternal-depression screening initiative. METHODS: The evaluation assessed staff compliance with a protocol for screening for depression among clients at regular intervals during the prenatal and postnatal periods until the client's child was two years old. Rates of acceptance of referral for treatment and treatment seeking as well as depression outcomes were measured. RESULTS: A total of 1,902 women were served by the Des Moines Healthy Start Project between 2002 and 2009. Compliance with the screening protocol was immediately high and increased significantly over the evaluation period, from 83% in 2002 to 98% in 2009. Of the 573 women who had elevated depression scores but who were not already in treatment, 64% accepted a referral, and 47% reported receiving treatment. Predictors of referral acceptance and treatment included higher depression scores and speaking English as a primary language. Depression severity significantly decreased for women who reported receiving treatment. CONCLUSIONS: A federal screening initiative identified a significant number of women who were at risk for maternal depression and connected them with treatment resources. Continuing work should assess the impact of this initiative on outcomes of women and children.