Postpartum depression screening: importance, methods, barriers, and recommendations for practice.

BACKGROUND Postpartum depression occurs in 10% to 20% of women who have recently given birth, but fewer than half of cases are recognized. The purpose of this review is to discuss the potential benefit of mass screening for improving postpartum depression recognition and outcomes. METHODS A review of the literature was conducted by searching MEDLINE, using the key words "depression," "postpartum depression," and "mass screening." The Cochrane database was also searched for reviews on depression and postpartum depression. RESULTS Opportunities for routine postpartum depression screening include mothers' postpartum office visits and their infants' well-child visits. Although several depression screens have been used in postpartum women, additional studies using large representative samples are needed to identify the ideal screening tool. Depression screening plus "high-risk" feedback to providers improves the recognition of depression. However, for screening to positively impact clinical outcomes, it needs to be combined with systems-based enhanced depression care that provides accurate diagnoses, strong collaborative relationships between primary care and mental health providers, and longitudinal case management, to assure appropriate treatment and follow-up. CONCLUSIONS Postpartum depression screening improves recognition of the disorder, but improvement in clinical outcomes requires enhanced care that ensures adequate treatment and follow-up.