Now what? Effects of on-site assessment on treatment entry after perinatal depression screening.

BACKGROUND Depression is a frequent accompaniment of the perinatal period. Although screening improves detection of perinatal depression, it does not in itself improve mental health treatment entry and, therefore, does not improve outcomes. This study addresses the feasibility of incorporating diagnostic assessment for depression directly into perinatal care visits and the influence of doing so on entry into mental health treatment. METHODS The Perinatal Depression Management Program was implemented in an urban community health center serving a predominantly Hispanic population. The Patient Health Questionnaire (PHQ-9) was administered during perinatal visits. Positive screens (scores ≥10) were followed within the same visit by brief diagnostic assessment and engagement strategies. Chart review was conducted to compare rates of screening, assessment, and treatment entry during a 3-month baseline period before implementation of the intervention (n=141) with a 1-year period after implementation of the intervention (n=400). RESULTS Before the intervention, 65.2% of patients completed a PHQ-9, and 10% of patients with positive screens received on-site assessment. None of the patients with identified perinatal depression entered treatment. After model implementation, significantly more (93.5%) completed a PHQ-9, and of patients with positive screens, 84.8% received an on-site assessment. Among patients diagnosed with major depression and offered treatment, 90% entered treatment. CONCLUSIONS It is feasible to implement diagnostic assessment for depression within perinatal clinic visits. Doing so may substantially increase entry into mental health treatment for women with perinatal major depression while reducing unnecessary mental health referral of patients with false positive screens.