Initiating Perinatal Depression Screening in a Rural Michigan WIC Clinic

Background: Up to 15% of people in the U.S. experience perinatal depression (PND). Research suggests that PND goes undetected in over 50% of cases primarily due to a lack of screening. When PND screening occurs, it is typically done at OB/GYN appointments for birthers and pediatric visits for infants. Rural perinatal people experience depression at higher rates than non-rural peers, yet face greater barriers to screening given the lack of local health and mental health providers. It is critical to identify accessible community-based settings where PND screening can occur in rural areas.The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offers a potential site to initiate PND screening. WIC serves low-income pregnant and postpartum people with risk factors for depression in a non-stigmatized setting. This study examines PND the impact of a community-university partnership to initiate PND screening in one rural WIC clinic.

Methods: Social work researchers and a rural Michigan WIC clinic collaborated to initiate PND screening and treatment referral as part of standard WIC practice. Researchers developed a multi-method training for WIC staff including four asynchronous online modules and a 2-hour synchronous, interactive workshop. Training was designed to be low burden staff, yet ensure WIC staff gained knowledge and skills needed to identify clients with PND and provide referrals. WIC clients screening positive for depression were provided a resource and referral directory as well as the option to engage with a free, technology-assisted, entertaining PND treatment. De-identified data on screening and referrals were tracked via an online database from March 2021 through September 2022. Descriptive statistics were used to assess screening and referral rates among perinatal clients.

Results: Four WIC staff members completed training and screened clients for PND. Between March 2021 and September 2022, WIC staff screened 979 perinatal clients. Twenty-one percent of perinatal clients (21%; n=202) screened positive for depression based on the Patient Health Questionnaire-2 (PHQ-2). On average, WIC clients scored 2.74 (SD=1.10) on the PHQ-2. Almost 60% of clients who screened positive for depression (59%; n=120) accepted a referral for the free, technology-assisted, entertaining depression treatment. Perinatal clients who did not accept the referral for the technology-assisted treatment (n=82) most commonly indicated that they were too busy to commit (n=22; 26.8%) or were already receiving mental health care (n=17; 20.7%).

Conclusions: Rural WIC clinics offer a potentially promising site for initiating PND screening and providing treatment referrals. Our findings suggest WIC staff were receptive to and successful in screening clients for PND as a part of standard practice, with low burden yet robust training. Results also indicate that there is a high prevalence of PND among rural WIC clients and that clients are interested in accessing free, technology-assisted depression treatment through WIC.