In an analysis of barriers to meeting postpartum depression (PPD) screening guidelines, researchers found that nurse practitioners (NPs) in Oregon were less likely to meet minimum standards of screening compared with their physician counterparts, according to a study published in the Journal of the American Association of Nurse Practitioners.1

PPD affects between 10% and 19% of women up to 1 year following delivery and is more common among women in low-income households.2,3 Despite its high incidence in new mothers, PPD is the most underdiagnosed obstetric complication in the United States.4 This led researchers to question how primary care screening practices in Oregon compare to PPD guidelines established by both women’s health and pediatric organizations. In addition, researchers also examined how factors like funding, patient demographics, and practice size and location influence the quality of screening practices.

A total of 1201 NPs and 686 physicians completed a survey via email that assessed their timing, tools, referral processes, and influence of payment type with respect to PPD screening. The zip code of their practice was used to separate participants into 3 groups: urban, rural, or frontier.

Respondents was asked 2 key questions about their PPD screening protocol: do they (or any personnel) screen women for PPD when they see the woman or her child aged ≤1 year; and do they adhere to standardized guidance when screening women for PPD, use their clinical judgment, or a mix of both. Respondents had the option to state that they screen at every contact, or could indicate custom timing, state that they screen only if PPD is clinically indicated, or if they do not screen at all.


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The final sample included 21 physicians and 34 NPs; the majority of participants were White (81.8%), women (89.1%), and had provided postpartum care for >5 years (65.5%). Sixteen of the respondents reported meeting screening standards established by the American Academy of Pediatrics (AAP).  Of the remaining respondents, 36 failed to meet AAP guidelines and 3 did not provide sufficient information.

A total of 35 participants stated that they used a standardized screening tool at least once during the postpartum period in accordance with USPSTF and NAPNAP screening guidelines; of these, however, 34.3% stated lack of staff and time were barriers to screening.

Seventeen participants (31%) only screened if clinically indicated and/or did not use any standardized tools during the screening period. The most common barrier to providing more extensive screening cited by the 17 participants was limited knowledge and/or availability of referral services (41.2%).

Of importance, the results of the survey found that physicians had higher rates of providing at least some screening compared with NPs. The results of this study may have been limited by the low response rate to the emailed survey.

“This study, although limited in scope, provides tentative evidence for the need for clarity in terms of PPD screening practice across the first postpartum year,” concluded the authors.

References

  1. Docherty A, Najjar R, Combs S, Woolley R, Stoyles S. Postpartum depression screening in the first year: a cross-sectional provider analysis in Oregon. J Am Assoc Nurse Pract.  2020;32(4):308-315.
  2. Drury SS, Scaramella L, Zeanah CH. The neurobiological impact of postpartum maternal depression: prevention and intervention approaches. Child Adolesc Psychiatr Clin N Am. 2016;25(2):179-200.
  3. França UL, McManus, ML. Frequency, trends, and antecedents of severe maternal depression after three million U.S. births. PLoS One. 2018;13(2):e0192854.
  4. Earls MF; Committee on Psychosocial Aspects of Child and Family Health American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2020;126(5):1032–1039.