Date

5-2015

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health & Preventive Medicine

Institution

Oregon Health & Science University

Abstract

a. BACKGROUND The perinatal time is a period of psychological vulnerability with depression and anxiety having been reported in up to 44% of pregnant women, leading to morbidity to both mother and baby. No consensus has been reached by any official organization about the specifics of perinatal depression screening, and current screening practices vary widely. The current study evaluates prenatal depression screening among obstetrics providers in Oregon.

b. METHODS This is a cross-sectional survey of OB/GYNs and FM physicians licensed by the Oregon BME as well as CNMs licensed with the ACNM who provided prenatal care in Oregon in 2014. A REDCap link for a self-administered online survey was emailed to 569 providers. Descriptive statistics were compiled for each provider subgroup. Associations in the CNM subgroup were analyzed by Fisher’s Exact testing, significant at an alpha of 0.05. The survey period ran from October to December, 2014.

c. RESULTS Of the 535 providers who received the survey, 106 responded (19.8%). Of these, 75 (71%) had provided prenatal care in the year prior to survey. 92% of respondents reported screening for prenatal depression. Most providers who screened reported using a standardized tool (75%), the majority using the EPDS on most prenatal patients. Mental health follow-up was most often to an outside provider, though a large proportion of respondents reported in-house services.

Further analysis focused on CNM care. Among CNMs, 94% reported screening for prenatal depression, the majority with a standardized tool on most patients. The timing of screening was quite variable, including a third of providers with no predefined screening time. Mental health referral was to external providers, and there was only marginal and non-significant association between the proportion of prenatal patients screened and the availability of in-house mental health (p-value=0.10). Screening did not appear associated to geography, patient volume, in-house mental health, practice size, age, or years in practice. Use of a standardized tool was significantly associated with urban practices (p=0.02) and medium-sized practices (p=0.02) but not with patient volume, in-house mental health, age, or years in practice. The most often cited barriers to prenatal depression screening were availability of mental health, insurance constraints and physician time. The small group of respondents who did not screen noted that lack of time was the biggest barrier to screening.

d. CONCLUSION AND DISCUSSION This is one of the first studies to evaluate CNM prenatal depression screening practices, and the first study of Oregon providers. The proportion of CNMs screening was quite high, although as a self-administered survey, this study is prone to selection bias and may overestimate this proportion. Though mental health availability, insurance constraints, and physician time were considered the most important barriers to screening, few respondents reported not screening. Additional studies are recommended to evaluate non-screeners for perceived limitations. More studies are also needed to more comprehensively evaluate practice differences among OB providers with respect to prenatal depression screening. Based on the low response rate among physicians, future studies should use a different delivery method to increase response rate.

Identifier

doi:10.6083/M41G0K1F

School

School of Medicine

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