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Psychiatric Briefs

Prim Care Companion J Clin Psychiatry 2007;9(2):157-164
Objectives: The study goals were to (1) establish the feasibility and yield of maternal depression screening during all well-child visits, (2) comprehend how pediatricians and mothers react to depression screening information, and (3) evaluate the time necessary for discussion of screening results. 

Method: Administration of brief depression screening of mothers at wellchild visits for children of all ages in 3 rural pediatric practices was evaluated. Two screening trials introduced screening (1 month) and then established the feasibility of sustaining screening (6 months). Screening was conducted with the 2-question Patient Health Questionnaire. Practices followed the ratios of visits screened and supplied data concerning the screening process.

Results: Practices were able to screen in the majority of well-child visits (74% in trial 1 and 67% in trial 2). Of 1398 mothers screened, 17% had 1 of the depressive symptoms and 6% (N = 88) scored as being at risk for a major depressive disorder. When these results were discussed with mothers, 5.7% suspected that they might be depressed, while 4.7% characterized themselves as stressed but not depressed. Pediatric clinicians took action with 62.4% of mothers who screened positive and 38.2% of mothers with lesser symptoms. Interventions included talking about the effect on the child, a follow-up visit or call, and referral to an adult primary care provider, a mental health clinician, or community supports. In the second trial, less time was needed by pediatricians to discuss screening results. Extended time devoted to discussion time was rare (5–10 minutes in 3% of all well-child visits and > 10 minutes in 2%). 

Conclusions: Regular, short, maternal depression screening carried out during well-child visits was feasible and revealed mothers ready to talk about depression and stress issues with their pediatrician. Postscreening discussion disclosed more mothers who felt depressed among those with lesser symptoms. The additional discussion time was generally short and prompted specific pediatrician interventions.