Public health implications of postpartum depression

Kimberly J Nylen; Lisa S. Segre

doi:10.3928/0048-5713-20050701-18

Despite the availability of efficacious treatments, postpartum depression is under-detected and consequently undertreated, a phenomenon that has negative implications for women, families, and society. Many studies suggest that screening for postpartum depression is associated with increased detection, treatment referral and use, and improved outcome. quality of life for women and their families. Further, there is a great need for additional research aimed at understanding the barriers to care and women's preferences for treatment, particularly among low-income and minority women, who are at higher risk for postpartum depression, yet are less likely to use treatment. Finally, research is needed to determine the optimal setting, timing, and frequency for postpartum depression screening. Together, these lines of research will likely prove useful in the development of easy to implement, cost-effective treatment models that encourage adherence, are acceptable to women of diverse backgrounds, and substantially reduce morbidity. Best practices for clinical care suggest that primary care providers address issues of detection, effective referral, and follow-up for pregnant and postpartum women. Probably the key activity for primary care providers is to establish relationships with mental health providers. These mental health providers should represent a range of mental health disciplines and settings because women will have diverse preferences and abilities to pay for care. It is also probably the case that primary care providers must rely on their nursing staff, physician assistants, and office staff to assist in the process of screening women and making referrals and conducting brief follow-ups to ensure that women are receiving care. Finally, a decision must be made as to whether to use a brief depression screening tool, such as the EPDS, or some other form of detection such as a brief personal assessment conducted by the provider or a staff member. These tasks will require a significant investment of planning time and effort on the part of all primary care staff. However, implementation of an effective program of detection, referral, and follow-up for depressed pregnant and postpartum women will pay significant dividends for the overall health of the woman, her child, and the entire family.

Public health implications of postpartum depression

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