Patient outcomes following positive depression screening in a postpartum clinic: A single center retrospective cohort study.

BACKGROUND: Depression screening using the Edinburgh Postnatal Depression Scale 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 depression screen at the 6-week postpartum clinic between 2014-2023. Exposure was categorized as screen negative (Edinburgh Postnatal Depression Scale 0-9) or screen positive (Edinburgh Postnatal Depression Scale ≥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 depression screen up to 1 year after childbirth. Secondary outcomes: the proportion of patients 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 depression screening; and psychiatric (medications, hospitalizations, mental health diagnoses) 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 depression 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 divorced, separated and widowed 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, mental health diagnoses and infant associated outcomes were more frequent following positive screening. CONCLUSION: Positive postpartum depression screening was associated with increased referrals to social work and psychiatry services; however, a critical gap persists between positive screening and specialty referral, diagnosis, and initiation of treatment. Findings support longitudinal mental health screening across the peripartum period.