Prenatal Depression Screening and Follow-up (PND-E)

The percentage of deliveries in which persons were screened for clinical depression while pregnant and, if screened positive, received follow-up care. 

  • Depression Screening. The percentage of deliveries in which persons were screened for clinical depression during pregnancy using a standardized instrument.
  • Follow-Up on Positive Screen. The percentage of deliveries in which persons received follow-up care within 30 days of a positive depression screen finding.

Why it Matters

Depression is an overwhelming feeling of sadness and hopelessness that can last for months or years. Maternal depression is an all-encompassing term for the spectrum of depressive conditions that can affect people when they are pregnant and after giving birth. Perinatal depression refers to minor and major depression episodes during pregnancy and/or the first 12 months after childbirth 1. Perinatal depression rates among women range from 12%–15%, with postpartum depression rates alone estimated to be as high as 20% in some parts of the United States 2.

Depression has significant consequences for birthing people, their infants and their families 3. Women with untreated depression during pregnancy are at risk of developing severe postpartum depression and suicidality, and of delivering premature or low-birthweight babies 4. Postpartum depression hinders infant attachment, bonding and can lead to developmental disorders that last into adolescence. During infancy, important caregiving activities such as breastfeeding, sleep, adherence to well-child visits and vaccine schedules can be compromised in depressed mothers 5 6.

Screening for and treating postpartum depression has been shown to be cost-saving. One study found that screening for and treating postpartum depression and psychosis cost an estimated $1,000 per woman resulting in an estimated $10,200 in savings per remission 7.

The PDS-E and PND-E measures are based on recommendations from the U.S. Preventive Services Task Force (USPSTF) and American College of Obstetricians and Gynecologists (ACOG) 8 9 10. The USPSTF recommends screening for pregnant and postpartum women. The ACOG recommends multiple postpartum visits no later than 12 weeks after birth that include a full assessment of psychological well-being, including screening for postpartum depression and anxiety with a validated instrument. The American Academy of Pediatrics (AAP) recommends that pediatricians screen mothers for postpartum depression at the infant’s 1-, 2-, 4- and 6-month visits 11. The USPSTF and ACOG also recommend that screening be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate follow-up.

Note: Not all people who become pregnant or give birth identify as women or mothers, and we prioritize the use of non-gendered language throughout this volume. However, the terms “women,” “mother” and “maternal” have been used historically to describe this concept, and we use them here to avoid editing cited data.

Developed with support from the California HealthCare Foundation (CHCF). CHCF works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit https://www.chcf.org/ to learn more. Also supported by the Zoma Foundation.

Historical Results – National Averages

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Results

NCQA published a special report summarizing HEDIS measurement year 2020 results for eight measures that leverage electronic clinical data, including this measure. This report can be found here: www.ncqa.org/ecds.

References

  1. Dagher, R.K., H.E. Bruckheim, L.J. Colpe, E. Edwards, D.B. White. 2021. “Perinatal Depression: Challenges and Opportunities.” J Womens Health (Larchmt) 30(2):154–9.
  2. Ko, J.Y., K.M. Rockhill, V.T. Tong, B. Morrow, S.L. Farr. 2017. “Trends in Postpartum Depressive Symptoms — 27 States, 2004, 2008, and 2012.” MMWR Morb Mortal Wkly Rep 66:153–158. doi:http://dx.doi.org/10.15585/mmwr.mm6606a1
  3. Klawetter, S., C. McNitt, J.A. Hoffman, et al. 2020. “Perinatal Depression in Low-Income Women: A Literature Review and Innovative Screening Approach.” Curr Psychiatry Rep 22, 1.
  4. Chan, J., A. Natekar, A. Einarson and G. Koren. March 2014. “Risks of Untreated Depression in Pregnancy.” Can Fam Physician 60(3): 242–43.
  5. Centers for Disease Control and Prevention. 2022. “Vaccinating Pregnant Patients.” Updated December 1, 2022. https://www.cdc.gov/pertussis/pregnant/hcp/pregnant-patients.html#:~:text=Tdap%20during%20pregnancy%20provides%20the%20best%20protection&text=The%20study%20found%20that%20getting,younger%20than%202%20months%20old
  6. Gregory, E.F., A.M. Butz, S.R. Ghazarian, S.M. Gross, S.B. Johnson. 2015. “Are Unmet Breastfeeding Expectations Associated With Maternal Depressive Symptoms?” Acad Ped 15(3):319–25.
  7. Wilkinson, A., S. Anderson, and S.B. Wheeler. 2017. “Screening for and Treating Postpartum Depression and Psychosis: A Cost-Effectiveness Analysis.” Maternal Child Health J 21(4), 903–14.
  8. U.S. Preventive Services Task Force (USPSTF)a. 2016. “Screening for Depression in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement.” Annals of Internal Medicine 164:360–6.
  9. U.S. Preventive Services Task Force (USPSTF)b. 2016. “Screening for Major Depressive Disorder in Adults: US Preventive Services Task Force Recommendation Statement.” Journal of the American Medical Association 315(4):380–7.
  10. American College of Obstetricians and Gynecologists (ACOG). 2018. “Screening for Perinatal Depression. ACOG Committee Opinion No. 757.” Obstetrics & Gynecology 132(5):e208-12.
  11. Lamere, K., N. Golova. 2022. “Screening for Postpartum Depression During Infant Well Child Visits: A Retrospective Chart Review.” Clin Pediatr (Phila). 61(10):699-706. doi:10.1177/00099228221097272

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