Screening for PPD: Predictors of Participation in a Screening Initiative

Background: Postpartum depression (PPD) is a serious disorder that effects many women worldwide and has negative effects on their babies and families. Although PPD is a treatable condition many women are not detected and do not turn for help. Routine screening has been found to increase the rate of PPD diagnosis. Nevertheless, even though screening initiatives have been implemented in many countries around the world, whether as national or local initiatives, not all postpartum women participate in them. To date, data is lacking on the differences between women who participate and those who do not in screening initiatives and on predictors of participating in such initiatives. This study compared women who participated in a screening initiative to those who did not and examined the predictors of participating in a screening initiative.

Method: Women (n= 1059) were recruited one to two days postpartum from the maternity department at a large hospital in Jerusalem, Israel, and completed a baseline survey providing data on maternal age in years, number of children (1= 1-2 children; 2= 3 or more children), family income (1= below average income; 2= average income and above), religious affiliation (1 = ultraorthodox; 2 = non-ultraorthodox), history of depression (1 = yes; 2 = no), family history of depression (1 = yes; 2 = no), and attitudes toward seeking professional psychological help. Participants were then followed up and screened for PPD symptoms at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS).

Results: 805 of the 1059 (76%) women participated in the 6-week screening. Women who participated in the screening initiative were significantly older, had more children, a higher income, more positive attitudes towards seeking help, and were more likely to have someone in their family with a history of being treated for depression than women who did not participate in the screening initiative. A logistic regression analysis showed that predictors of participating in the screening initiative included having 3 children or more (compared to 1-2 children), having someone in their family with a history of being treated for depression, and having more positive attitudes towards seeking help (OR 1.494 [95% CI 1.012-2.207], OR .486 [95% CI .288-.822], and OR .985 [95% CI .970-.999] respectively).

Implications: Those who screen women for PPD should bear in mind that women may be excluding themselves from being screened. If the goal of screening initiatives is to diagnose women and get more women with depressive symptoms into treatment then careful attention should be given to possible interventions for enhancing the number of participants in such initiatives. For example, based on this study's finding that women with 1-2 children are less likely to participate in a screening initiative, a reaching-out program should be targeted at these women in order to increase the number of new mothers who are screened and ultimately referred for treatment. In addition, national and local campaigns should focus on changing negative attitudes toward seeking help for PPD, helping the public be aware of the importance of being screened for PPD.