Infant Outpatient Visit Patterns Identify Mothers at Risk for Postpartum Depressive Symptoms ♦ 356

Two percent of postpartum women are diagnosed with depression; 10-40% exhibit high levels of depressive symptoms. Maternal depression has substantial adverse impact on infant and child development. Hypothesis. Women whose neonates have frequent problem-oriented primary care visits (PPCV), or emergency department visits (EDV), have increased risk of postpartum depressive symptoms. Methods. Design: Secondary analysis of a prospective cohort study designed to measure the effects of inpatient postpartum services on maternal and infant health outcomes. Setting: Urban teaching hospital. Subjects: Consecutive mother-infant dyads with DRG 372 or 373 (vag delivery with or without complications). Measures: Independent variables were >1 PPCV and EDV. Covariates were maternal age, race, Hispanic ethnicity, parity, educational level, income, and payor status. Depressive symptoms were assessed by the Center for Epidemiologic Studies depression scale (CES-D). The dependent variable was CES-D>16, at 8w. Independent and outcome data were assessed by telephone survey at 3 and 8w postpartum. Results. Of 1364 eligible patients, 1200 (88%) were surveyed at 3w, and 1015 (85%) re-surveyed at 8w. Within 21d, 7.6% of infants had >1 PPCV and 5.1% had an EDV. At 8w, 9.2% of mothers had depressive symptoms. EDV and >1 PPCV are significant predictors, before and after adjustment for covariates through logistic regression. (See Table) Positive predictive value (PPV) for depressive symptoms of an EDV is 0.23 [95%CI 0.17,0.39]. Conclusions. Women whose infants have EDV and PPCV are more likely to exhibit depressive symptoms at 8w. We cannot, from these data, discern cause and effect. Either way, whether depression is the basis or the result of these infant outpatient visit patterns, the risk groups identified need close monitoring. Referral of mothers by pediatric health providers recognizing these patterns may facilitate early diagnosis and treatment of postpartum depression, improving outcomes for women and their families.

Table 1