The American College of Obstetrics and Gynecology (ACOG) has published a Committee Opinion emphasizing the importance of screening for depression during pregnancy and the postpartum period. Clinical depression is common among women of reproductive age and is the leading cause of disability in U.S. women each year. However, ACOG acknowledged that there is a paucity of data to support a firm recommendation for universal screening, which screening tools to use, and how often to use them.

According to the report, published in the American College of Obstetricians and Gynecologists, screening for depression during pregnancy and afterward benefits women, infants, and families. Because pregnancy and the postpartum period are pivotal times to identify women suffering from depression, the ACOG encourages all obstetricians and gynecologists to strongly consider screening their patients.

Between 14% and 23% of pregnant women will experience depression symptoms during pregnancy, and an estimated 5% to 25% of women will have postpartum depression. Studies have shown that untreated maternal depression negatively affects an infant’s cognitive, neurologic, and motor skill development. A mother’s untreated depression can also negatively impact older children’s mental health and behavior. During pregnancy, depression can lead to preeclampsia, preterm delivery, and low birth weight.

There are multiple depression screening tools that typically take under 10 minutes and have a specificity ranging from 77% to 100%, according to the guidelines. One of the most validated is the Edinburgh Postnatal Depression Scale, according to the ACOG president Gerald Joseph, MD. Each medical practice should have a referral process in place for women who screen positive and require further evaluation and possible treatment no matter which screening tool is chosen, the writing committee emphasized.

Another challenge with screening patients in an OB/GYN practice is the issue of insurance reimbursement for providing mental health services. Many payers require that evaluation and management be done only by a psychiatrist, psychologist, or social worker and will crosscheck the provider’s specialty, the guidelines warned. Therefore, the committee opinion recommends that medical practices check ahead of time with all payers before billing for depression screening.

1. Committee on Obstetric Practice. Committee opinion no. 453: screening for depression during and after pregnancy. Obstet Gynecol. 2010;115:(2) Part 1:394-395. Available at: http://journals.lww.com/greenjournal/Citation/2010/02000/Committee_Opinion_No__453__Screening_for.34.aspx. Accessed February 16, 2010.
   

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This entry was posted on Tuesday, February 16th, 2010 at 12:00 pm.