Patient outcomes following positive depression screening at the postpartum clinic: a single center retrospective cohort study

Abstract

Background: Edinburgh Postnatal Depression Scale (EPDS) screening is commonly performed at the 6-week postpartum visit, yet subsequent referral patterns and clinical outcomes are incompletely characterized.

Methods: A single center cohort study was conducted using electronic health records of patients with a completed EPDS screen at the 6-week postpartum clinic between 2014-2023. Exposure was categorized as screen negative (EPDS 0-9) or screen positive (EPDS >=10) for depressive symptoms. Primary outcome: the proportion of new mental health referrals made (to social work and/or psychiatry services) following the 6-week postpartum EPDS screen up to 1 year after childbirth. Secondary outcomes: the proportions referred to each specialty after 6 weeks and during the peripartum period (antenatal to 1 year postpartum); patient variables associated with specialty referral from 6 weeks to 1 year postpartum using a multivariable logistic regression model; timing of postpartum referrals after 6-week EPDS screening; and psychiatric (medications, hospitalizations, ICD10 mental-health diagnosis code) and infant associated outcomes within 1 year of childbirth.

Results: Of 41,790 deliveries, 8,155 patients met inclusion criteria. 12.6% received a new mental health referral following 6-week postpartum EPDS screening up to 1 year after childbirth. After screening, social work and psychiatry referrals occurred in 4.7% and 3.7% of negative-screened patients and 37.1% and 19.5% of positive-screened patients, respectively. Across the peripartum period, social work and psychiatry referrals occurred in 8.6% and 17.5% of negative-screened patients, and 42.0% and 42.5% of positive-screened patients, respectively. Variables associated with referrals (6 weeks to 1 year postpartum) included marital status, ASA grade >=3, delivery of a non-viable fetus, neonatal intensive care hospitalization, psychiatric diagnosis, and medication use. Referrals within 2 months postpartum were more frequent following positive screening compared to negative screening; Social Work (84% vs 49%); Psychiatry (53% vs 32%). Psychiatric medications, hospitalizations, ICD10 mental-health diagnoses and infant associated outcomes were more frequent following positive screening.

Conclusion: Positive EPDS screening postpartum was associated with increased referrals to social work and psychiatry services; however a critical gap persists between positive screening and specialty referral, diagnosis, and treatment initiation. Findings support longitudinal mental health screening across the peripartum period.