Highlight
- Mandatory Edinburgh Postnatal Depression Scale (EPDS) screening in an urban medical center dramatically increased perinatal depression detection rates from 1.0% to 14.2%.
- Among screened women, 23.2% reported clinically meaningful depression symptoms, and 8.8% endorsed suicidality, emphasizing significant unmet mental health needs.
- Only 17.1% of screened women received mental health services, which were associated with faster and sustained reductions in depression severity postpartum.
Study Background and Disease Burden
Perinatal depression and anxiety represent common but often underdiagnosed and undertreated complications affecting women during pregnancy and the postpartum period. These disorders are linked to adverse outcomes for both mother and child, including impaired bonding, developmental delays in offspring, and increased risk of maternal morbidity and mortality. Despite the clinical importance, robust data on screening rates, symptom severity, and treatment delivery remain sparse, particularly in large, diverse urban settings. This knowledge gap hampers timely, effective interventions and exacerbates health disparities. Accurate prevalence estimates and characterization of symptom trajectories are essential to improve clinical protocols and healthcare policies aimed at perinatal mental health.
Study Design
This retrospective cohort study analyzed electronic health records (EHR) from 27,393 women who gave birth at NewYork-Presbyterian/Weill Cornell Medical Center and NYP Lower Manhattan Hospital between December 1, 2020, and February 1, 2024. In March 2023, a policy mandating EPDS screening was implemented in three clinics accounting for approximately 35% of hospital deliveries. The study examined three validated mental health assessment tools administered during the perinatal period (one year before to one year after delivery): the Patient Health Questionnaire-9 (PHQ-9) for depression severity, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety severity, and the EPDS specifically validated for perinatal depression screening.
Primary outcomes included screening rates, prevalence of clinically meaningful symptoms, frequency of mental health service utilization, and symptom trajectories analyzed via mixed effects models. The study also evaluated associations between treatment exposure, patient characteristics, and symptom changes over time.
Key Findings
From the initial cohort, 3,051 women (mean age 34.3 years, range 14-54) completed perinatal screening for depression or anxiety within one year pre- or postpartum. Depression screening (PHQ-9) was completed by 723 women (3.0%), and anxiety screening (GAD-7) by 472 women (2.0%). Before the mandatory EPDS screening implementation, only 1.0% (274 women) were screened using the EPDS, which substantially increased to 14.2% (2304 women) post-policy enforcement.
Among those screened, 23.2% (95% confidence interval [CI], 21.7%-24.8%) reported clinically significant depressive symptoms, and 8.8% (95% CI, 7.2%-10.8%) endorsed suicidality. However, only 523 women (17.1%) obtained mental health services, primarily psychosocial interventions provided around 4 months before and after delivery.
Longitudinal analysis revealed that treated women experienced significantly faster reductions in depression severity measured by PHQ-9 scores over time (F1,1504 = 9.6; P = .002) and maintained a sustained decline in depressive symptoms postpartum compared with untreated counterparts (F1,5166 = 33.8; P < .001). These findings highlight the effectiveness of mental health intervention during the perinatal period in modifying symptom trajectories favorably.
Expert Commentary
This study underscores a critical gap between the recognition of perinatal mood disorders and the adequate delivery of screening and treatment within large urban healthcare settings. The striking increase in screening rates following the mandatory EPDS policy demonstrates institutional capacity to improve detection but also reveals persistent challenges with incomplete coverage, as only a minority of women were screened even after policy changes.
The relatively low treatment uptake among those with clinically meaningful symptoms indicates barriers including stigma, resource availability, and possible provider hesitancy, warranting targeted strategies to improve engagement. The observed amelioration of depression symptoms in treated women aligns with existing literature endorsing psychosocial therapies and signifies a positive modifiable outcome with appropriate intervention.
Limitations of this study include potential selection bias from screening compliance variability, limitation to three clinics for screening mandate, and the retrospective design reliant on EHR completeness. Further prospective studies could elaborate on anxiety trajectories and incorporate biological or psychosocial moderators of treatment response.
Conclusion
Perinatal depression and anxiety continue to impose a substantial health burden within urban medical centers, with underdiagnosis and undertreatment remaining significant hurdles. Mandatory EPDS screening policies can markedly improve detection rates but must be coupled with assurance of comprehensive access to efficacious mental health services.
This study confirms that women receiving mental health interventions, primarily psychosocial support, experience accelerated and sustained reduction in depressive symptoms postpartum. Scaling such interventions represents a clinical priority to mitigate morbidity associated with perinatal mental health disorders.
Health systems should implement universal screening integrated within routine prenatal and postpartum care pathways, ensure equitable treatment access, and promote multidisciplinary collaboration to optimize maternal mental health outcomes.
References
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3. Stewart DE, Vigod S. Postpartum depression: Pathophysiology, treatment, and emerging therapeutics. Annu Rev Med. 2019;70:183-196. doi:10.1146/annurev-med-042617-105218
4. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150(6):782-786. doi:10.1192/bjp.150.6.782
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