Screening for postnatal depression: Not a simple task

Abstract

Objective: To evaluate an established screening program for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS) in a rural Victorian shire. By protocol, all women were screened at three time points post delivery by maternal and child health nurses. The efficacy of this approach in detecting probable depression was examined and referral pathways analysed. Methods: Records for a 12-month cohort of women giving birth in the shire were audited (n=267). Information collected included EPDS scores, parity, mother's age, reasons for non-completion, referral details and nurses' comments. Analysis was completed using database and SPSS programs. Results: The process goal of screening on all three occasions was rarely achieved - a goal met for only 15.5% of women; 22% were never screened at all. The highest rate of screening was 50.6% at one month, falling to 38.1% at eight months. Reasons for non-screening varied, suggesting no simple remedy. The proportions of women identified as probably depressed at each screening point (3.1%, 4.8% and 9.2%) were considerably lower than statewide figures for rural women. Referrals of probably depressed women were mainly to GPs but the results were unclear. Conclusions: A well-established program of universal screening was not effective in detecting probable depression in women. There was little evidence of direct feedback from GPs about women referred as a result of screening and no collaborative planning for affected women. Before universal screening of women for postnatal depression can be recommended, better evidence of its feasibility and acceptability are required, alongside convincing evidence that screening leads to improved outcomes for women.