Screening for perinatal depression became a required component in the third funding cycle of Healthy Start. The recent focus on perinatal depression is in response to increasing evidence that links depression and stress to adverse pregnancy outcomes. Maternal depression can lead to poor self-care and poor infant care, and in extreme cases, to suicide or infant death. With early detection and intervention, depression can be treated and functioning improved.

During 2003, all but one grantee provided perinatal depression services; the remaining grantee reported that services were under development. By far, the most commonly used screening tool was the Edinburgh Postnatal Depression Scale (EPDS) (used by 67 percent of grantees). More than two-thirds of the grantees reported that they screened at least three-fourths of their clients for depression. A sizable proportion of grantees reported that they achieved universal screening - that is, they screened all of their pregnant and interconceptional clients for depression (38 percent and 43 percent, respectively).

Several factors were associated with achieving universal depression screening of pregnant clients. Universal screening rates were higher among grantees that performed screening both separately and as part of a comprehensive screening (58 percent) compared to those that performed screening either separately (39 percent) or as part of a comprehensive screening (28 percent) (data not shown). Projects that screened at more points in time also were more likely to screen all their clients, suggesting that repeated screening attempts may reduce barriers and resistance to screening. Universal screening rates increased from 27 percent among grantees using only one screening interval, to 48 percent of those using four intervals, and 100 percent of those using five intervals. Grantees that involved direct employees or subcontractors in clinical assessment and diagnosis (49 percent) had higher universal screening rates compared to those that relied only on referrals (26 percent), suggesting that more monitoring and follow-up is required by grantees that use referrals.

When Healthy Start clients screen positive for depression, they require additional clinical assessments to confirm a mental health diagnosis and determine the necessary follow-up services. These subsequent clinical assessments can be provided by project staff or subcontractors, or through outside referrals, and by either specialty mental health providers or primary care providers. All of the grantees (100 percent) reported that further clinical assessment and diagnosis were available in their communities, and most (93 percent) indicated that these services were available from mental health providers, either alone or in combination with primary care providers.