According to a recently published study in the British Medical Journal (BMJ), Postpartum Depression Screening is not…. brace yourselves. Worth the cost.
In their cost effective analysis, the researchers used “A hypothetical population of women assessed for postnatal depression either via routine care only or supplemented by use of formal identification methods six weeks postnatally, as recommended in recent guidelines.”
The conclusion was that overall not using a formal screening method was much more cost effective as it eliminated false positives.
So the mental health of a woman which will then affect her child, her family, her community, the world at large, are just not worth it to the National Health System of the UK. The EPDS scored out at about $67,000 per quality adjusted life years while no screening method scored at a price tag of just $20 – $30,000. No value for the money was found to exist when using the formal identification methods.
Did these researchers not read Murray & Cooper’s Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression which explores the effects of postpartum depression treatments on children?
There is SO much more at stake here than the dollar value to the National Health System.
There’s the potential for broken families. The potential for children growing into their own mental health issues, the potential for continued need for mental health treatment due to an undiagnosed episode of postpartum depression, potential for increased incarcerations due to untreated mental illness, continued sadness, the continued stigma, continued and perpetuated lack of education on the part of physicians in regards to Postpartum Mood Disorders.
The most interesting aspect of this study is that it focused on screening for Postpartum Depression in the Primary Care setting. Primary care physicians are not always comfortable or knowledgeable in screening for mental health issues. If a patient were to screen positive, that physician is then morally responsible for referring them to a specialist. Often times, at least here in the states, a Primary Care physician is unaware of where to refer a patient for help with a Postpartum Depression Disorder. Therefore, they become afraid of screening because they fear what will happen if a positive were to occur. What would they do with the patient? Where would they send them? How would they respond? Are they familiar enough with Postpartum Mood Disorders to recognize a false positive?
I think the key to the results of this study is not so much in blaming the high percentage of false positives but in urging that Primary Care physicians receive more training to enable them to recognize a false positive through more in depth questions after a positive is scored via the Edinburgh Postnatal Depression Scale.
original photo/graphic "Hand holding necklace" by K.Sawyer @flickr
A stronger safety net involving a stronger communication between midwives, Obstetricians, Pediatricians, and General Practitioners is so desperately needed to keep women from falling through the very big cracks which currently exist in the system.
Let’s think about this for a moment, shall we?
A woman gets pregnant. She sees a medical physician to get the pregnancy confirmed. Most mothers seek OB or midwife care for their entire pregnancy. Unless they’re depressed – depressed and mentally ill mothers are less likely to take good care of themselves during a pregnancy, making specialized care even more important even when baby is still in utero. Once mothers give birth, they are then shuttled off to the pediatrician’s office for the bulk of their medical contact. One six week or eight week visit to the midwife or OB to ensure mom is healing properly then an annual PAP visit unless something arises in between. Many Pediatricians focus on babies and not mother. But the tide is changing as more and more Pediatricians are taking into account the family lifestyle and well-being. My own Pediatrician does this and I absolutely adore her for it.
But overall, there is typically no continuity of care, no communication between physicians throughout the birth process. There should be. There needs to be. A woman deserves a team of support. She deserves to thrive. So do her children.
No matter what the cost.
Because once you fail woman and her children, you fail society.
Fail society and we fail to exist.
If we fail to exist….