Differences in Screening and Treatment for Antepartum Versus Postpartum Patients: Are Providers Implementing the Guidelines of Care for Perinatal Depression?

Gina L. Fedock, Carmen P Alvarez

Research output: Contribution to journalArticlepeer-review

Abstract

Background: National guidelines recommend universal depression screening for perinatal patients and provide treatment recommendations to prevent adverse maternal/child health outcomes. However, providers rarely screen all patients, and most women with perinatal depression remain undertreated. This study investigated predictors of universal screening and guideline-congruent care for perinatal depression by obstetrician-gynecologists and examined differences in practices with pregnant and postpartum patients. Materials and Methods: A random, national sample of obstetric providers (n = 483) from a three-wave mailing completed the survey. Results: Regression analysis showed that providers universally screened (53.04% vs. 82.40%; p < 0.001) and implemented guideline-congruent care (33.61% vs. 58.51%; p < 0.001) with pregnant patients at a lower rate than with postpartum patients. Predictors of antenatal universal screening included the following: external influences, including screening as a clinic priority (adjusted odds ratio [AOR] 1.85; 95% confidence intervals [CIs]: 1.42-2.40), and intrinsic factors related to familiarity with mental health providers. Predictors of universal postpartum screenings included the following: clinic priority (AOR 3.01; 95% CIs: 2.12-4.28), provider comfort with diagnosing depression (AOR 1.58; 95% CIs: 1.04-2.39), and provider belief of patients unlikely to disclose depression unprompted (AOR 0.40; 95% CIs: 0.24-0.68). The only predictor of guideline-congruent care with pregnant patients was provider motivation (AOR 1.32; 95% CIs: 1.09-1.61). Predictors of postpartum guideline-congruent care included the following: comfort with prescribing antidepressants (AOR 1.98; 95% CIs: 1.53-2.57) and provider belief that depression will not resolve on its own (AOR 1.33; 95% CIs: 1.07-1.65). Conclusions: This study displays differences in perinatal depression care for pregnant and postpartum patients, particularly disparities for pregnant patients. The findings highlight facilitating factors for translating guidelines into routine practices.

Original languageEnglish (US)
Pages (from-to)1104-1113
Number of pages10
JournalJournal of Women's Health
Volume27
Issue number9
DOIs
StatePublished - Sep 1 2018

Keywords

  • depression management
  • perinatal depression
  • provider behavior
  • universal screening

ASJC Scopus subject areas

  • Medicine(all)

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