Timely and Documented Screening: A Crucial Step in Identification of Postpartum Depression

Introduction: Peripartum or postpartum depression (PPD) is a major depressive episode with peripartum onset. Despite its prevalence, PPD is under-screened, underdiagnosed, and undertreated. Standardized screening has been shown to improve PPD detection. Several professional societies including American Psychiatric Association recommend screening during pregnancy and postpartum. This study aims to provide updated data on PPD screening and diagnosis in the US to identify improvement opportunities.
Methods and Analysis: Patients pregnant in 2018 to 2021, aged 18-45 years, were included in this study using Optum’s de-identified claims database. Major Depressive Disorder (MDD; excluding those with active supply of antidepressants before conception) or PPD ICD-10-CM codes during pregnancy and up to 12 months postpartum were classified as PPD. Major exclusion criteria were bipolar disorder, schizophrenia, schizoaffective disorder, and psychosis; patients receiving lithium; or patients receiving an antipsychotic without a concomitant antidepressant. 308,406 individuals remained in the study population.
Results: The recorded screening rate was 16% of which 65% first screened postpartum. Women’s health (OB/GYN) (34%), Primary Care (29%), and Mental/Behavioral Health (27%) providers, completed most of the documented screening. The PPD diagnosis was 9% with the majority of these being coded using MDD claims (27% with PPD codes; 73% with MDD codes). Only 23% had a recorded screening prior to diagnosis.
Discussion: The rate of screening was low; possibly due to either not being recorded or not performed. Improved screening documentation and early diagnosis are crucial for effective and early treatment. Interventions should include PPD identification, care initiation, provider education, and system-level support.