Detection, Treatment, and Referral of Perinatal Depression and Anxiety by Obstetrical Providers

Aims: This study aimed to assess the rates of detection, treatment, and referral of maternal depression and anxiety by obstetrical providers during pregnancy and at 6 weeks postpartum. Methods: A convenience sample of women receiving obstetrical care at a large urban teaching hospital (n=491) was screened for depression and anxiety during the third trimester of pregnancy and again at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale and the anxiety portions of the Patient Health Questionnaire. Participants were also asked if they thought they needed help for depression, anxiety, or stress at the two time points. Obstetrical providers were blind to screening results. Two months postdelivery, each woman's obstetrical electronic medical record (EMR) was reviewed for documentation of psychiatric symptoms, diagnoses, psychiatric treatment, and mental health referrals at the two time points. Data were analyzed using descriptive statistics. Results: Twenty-three percent of participants screened positive for an anxiety disorder or high levels of depressive symptoms or both prenatally, and 17% screened positive at 6 weeks postpartum. The majority of women who screened positive were not identified by their providers during pregnancy or postpartum. Only 15% of positively screened participants had evidence of any mental health treatment in their EMR during pregnancy, with equally low rates of referral to mental health or social services. In the postpartum period, only 25% of positively screened postpartum women received treatment, and an additional 2.5% were referred. A low proportion of women who reported they felt a need for help with depression, anxiety, or stress prenatally or postpartum received treatment or referral. Conclusions: These findings indicate that detection, treatment, and referral of perinatal depression by obstetrical providers are seriously lacking and need to be addressed.