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

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.