Kaiser Permanente Screening Program Increases Identification and Treatment of Depression Among Pregnant and Postpartum Women

OAKLAND, Calif., April 7, 2016 /PRNewswire/ -- A universal screening program increased the number of women diagnosed and treated for depression during and after pregnancy and resulted in significant relief from their symptoms, according to two Kaiser Permanente studies published online today in the journal Obstetrics and Gynecology.

Perinatal depression (before and after birth) occurs in 12 to 20 percent of pregnancies, according to the U.S. Centers for Disease Control and Prevention. The consequences can include premature delivery, decreased maternal-child interactions, child behavior problems, and in severe cases, even suicide or infanticide. The American College of Obstetrics and Gynecologists and the U.S. Preventive Services Task Force recently recommended that clinicians screen patients at least once during the perinatal period for depression and anxiety symptoms using a validated tool, but such tools are rarely used.

Kaiser Permanente in Northern California initiated the development of a universal screening program in 2007. Women were screened with a nine-question survey at three times during the perinatal period: the first prenatal visit, at 24 to 28 weeks of gestation, and at three to eight weeks following birth.  Each woman's obstetrician reviewed the results and made referrals for treatments offered by Kaiser Permanente, such as classes, support groups, individual counseling, or medication.

"We identified best practices, empowered on-site champions to help educate clinicians about the program, streamlined the work flow for screening during office visits, and used data to continuously improve the program," said Tracy Flanagan, MD, director of women's health for Kaiser Permanente in Northern California, clinical lead of the screening program, and lead author of one of the studies.

At full implementation, the program screened 98 percent of pregnant and postpartum women at least once during and after pregnancy, and an average of 2.5 times per pregnancy. Fifteen percent of the pregnant women screened positive for depression and 6 percent screened positive for severe depression.

Researchers compared outcomes before, during and after implementation of the screening program for nearly 98,000 pregnancies between 2007 and 2014.

Among the women diagnosed with depression, 82 percent showed significant improvements in symptoms by six months postpartum, and 60 percent had symptoms that improved a minimum of 50 percent. Among women with severe depression, 57 percent had symptoms that were classified as mild by six months postpartum and 56 percent had symptoms that improved by 50 percent or more.

"Our studies provide evidence for the effectiveness of universal screening for perinatal depression in enhancing identification and treatment and, ultimately, improvement of outcomes," said Lyndsay Ammon Avalos, PhD, MPH, lead author of one of the studies and a research scientist in the Kaiser Permanente Northern California Division of Research. "Through collaborations with mental health professionals, the implementation of universal screening in health care plans can provide significant improvements in identifying and treating depression."

In addition to Avalos and Dr. Flanagan, co-authors of the study were Tina Raine-Bennett, MD, MPH, Hong Chen, MPH, and Alyce S. Adams, PhD, of the Kaiser Permanente Division of Research.

Avalos received funding for this study from the National Institute of Mental Health and the University of California, San Francisco/Kaiser Permanente Building Interdisciplinary Research Careers in Women's Health Program.

About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 550-plus staff is working on more than 350 epidemiological and health services research projects. For more information, visit www.dor.kaiser.org or follow us @KPDOR.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 10 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

For more information, contact:
Heather Platisha, [email protected], 415-262-5992
Janet Byron, [email protected], 510-891-3115

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SOURCE Kaiser Permanente

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