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Table 1 Characteristics of included articles

From: Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review

Author (year) Study design (sample size) Country Participant characteristics Postpartum depression Treatment
Race/ethnicity distribution Mean age Measure Definition Assessment Type Treatment outcome
Abrams et al. (2009) [28] Cohort (14) USA B—43%, L—57% 27 Self-report Self-report of PPD symptoms Self-assessment through focus groups, individual interviews No women in this study sought treatment No women in this study sought treatment
Beeber et al. (2004) [15] RCT (16) USA W—38%, B—62% 26.6 CES-D 16 or higher on CES-D Intervention group Therapeutic relationship with master-prepared psychiatric mental health nurse home visitor —8 face-to-face contacts over 8–10 weeks, then about 5 phone calls per week for 8 weeks 50% randomized to treatment intervention, no one in control group (n = 8) sought treatment during study period
Bobo et al. (2014) [34] RCT (2343) USA W—65%, B—15%, A—1%, U—19% 26.4 EPDS, PHQ-9 10 or more on EPDS or PHQ-9 Intervention group Nursing staff: follow-up telephone calls dealing with antidepressant drug therapy or counseling initiation, adherence, and adverse effects Treatment selection at discretion of participant (not reported); of 1246 who completed supplemental survey, 9.2% were unable to access treatment
Broom et al. (2015) [30] Cohort (58) USA W—14%, B—83%, M—3% NR EPDS, BDI-II 10 or more on EPDS All study participants received treatment Supportive 4 text messages/week for 6 months; CBT counseling—unlimited access to therapeutic services and telephone support CBT use not reported; 1.9% of total texts sent requested a call back from researchers
Callister et al. (2011) [35] Cohort (20) USA L—100% 24 PDSS-Spanish Cutoff score of 60 on PDSS for positive screen Interview Interview to assess PPD thoughts, treatments, and barriers Women were not directly asked about their own treatment
Chaundron et al. (2005) [27] Cohort (218) USA L—100% 26.5 EPDS Self-recognition: “yes” to question, “have you thought that you needed help with sadness or depression”; 10 or more on EPDS Self-report Referral to mental health specialist after self-report to physician 28% of participants felt they needed help, 47.5% of those participants spoke to a provider, and 33% of those were referred to a mental health specialist
Crockett et al. (2008) [32] RCT (36) USA B—100% 23.4 CSQ, EPDS 27 or more on CSQ, 10 or more on EPDS Intervention group Four 90-min weekly group sessions and a 50-min individual booster session 2 weeks after delivery 52.7% participants randomized to treatment
Geier et al. (2015) [36] Retrospective cohort (6030) USA W—9%, B—3%, A—1%, L—85%, O—1%, U—1% NR ICD-9 code Any ICD-9 code for depressive illness as primary or secondary diagnosis ICD-9 codes for treatment (1) Received antidepressant medication only, (2) received psychotherapy only, (3) received both antidepressant medication and therapy, and (4) received neither 4.1% received antidepressants postpartum; 56% of depressed cohort received treatment vs 74% of control group
Kozhimannil et al. (2011a) [40] Cohort (30,955) USA W—42%, B—43%, O—15% NR New Jersey’s Medicaid data No documented diagnosis to indicate treatment initiation Medicaid data on filling a prescription for antidepressant medication or having had an outpatient mental health visit in 6 months after delivery Antidepressants or outpatient mental health visit 7% initiated mental health treatment, of which 90% used outpatient mental health services and antidepressants
Kozhimannil et al. (2011b) [39] Retrospective cohort (29,601) USA W—44%, B—45%, A—11% NR ICD-9 code Any ICD-9 code for depressive illness as primary or secondary diagnosis ICD-9 codes for treatment Filling a prescription for antidepressant medication or having had an outpatient mental health visit in 6 months after delivery 9% white women, 4% black women, and 5% Latina women initiated treatment
Letourneau et al. (2007) [25] Cohort (41) Canada W—81%, N—10%, O—9% 31.27 EPDS 10 or more on EPDS Interview Support seeking, support needs, barriers to support, and preferences for support intervention 43.9% were unable to locate support programs for PPD; those with treatment not reported
Logsdon et al. (2009) [29] Cohort (9) USA W—22%, B—44%, L—22%, N—11% 16 Self-report Self-report of PPD symptoms Semi-structured interview: What actions might you take if you had a lot of negative (sad/unhappy) feelings after having a baby? Probes: Is there anything you can do? What might you do first? What do you think is the best way to handle a situation like this? Who would be someone you could go to help you? Anyone else? Have you had any experience in getting help in a situation like this? If so, what were the challenges to getting help with negative feelings after having a baby? No women in this study sought treatment Participants were asked if they had received help for negative feelings, but outcome is not reported in paper
McGarry et al. (2009) [26] Retrospective cohort (213) USA W—85%, O—15% NR Primary Care Evaluation of Mental Disorders Patient Health Questionnaire Response of “always” or “often” to the following: (1) Since your new baby was born, how often have you felt down, depressed, or hopeless? and (2) Since your new baby was born, how often have you had little interest or little pleasure in doing things? Survey question: “Since your new baby was born, did you seek help for depression from a doctor, nurse, or other health care worker?” Type of treatment not specified 60.5% (unweighted) women who reported PPD did not seek help
O’Mahoney et al. (2012) [37]; O’Mahoney et al. (2013) [38] Cohort (30) Canada B—7%, A—50%, L—43% NR EPDS 10 or more on EPDS Self-report in interview Type of treatment not specified Patents were unfamiliar with or unaware of treatment options
Price et al. (2009) [31] Cohort (1086) USA W—70%, B—27%, L—2%, O—1% 24.6 PHQ Published guidelines for PHQ Self-report on questionnaire Type of treatment not specified Treatment specific to postpartum women not reported: 38% sample with depressive symptoms, 3.4% postpartum, 2.3% current psychiatric medication use, and 5.5% current counseling
Song et al. (2004) [33] Cohort (3841) USA W—17%, B—83% 24.4 Psychiatric diagnosis DSM-III-R criteria for severe mental disorders, major depression, minor psychiatric disorders Medical chard codes for using mental health services Inpatient, outpatient mental health visits (psychiatrists, psychologists, psychiatric social workers, community psychiatric nurses) 6.4% used mental health services in postpartum period
Surkan et al. (2012) [24] RCT (679) USA L—75%, UTD—25% 26 CES-D Standard CES-D cut-off Randomized to control (WIC benefits) or intervention Five home visits, delivered by paraprofessionals, monthly phone calls from intervention staff 49.6% patients randomized to intervention with treatment
  1. NR not reported, W white, B black or African-American, L Latina, A Asian, U unknown, M multiple races, O other, N native, UTD unable to determine, CES-D Center for Epidemiologic Studies Depression Scale, EPDS Edinburgh Postnatal Depression Scale, PHQ-9 Patient Health Questionnaire, BDI-II Beck Depression Inventory, PDSS Postpartum Depression Screening Scale, ICS-9 International Classification of Diseases, CSQ Cognitive Style Questionnaire