Theoretical Framework: The Agency for Healthcare Research and Quality framework informs this study. The pathway begins with identifying a cohort of postpartum women with unknown mood state and moves to symptom screening, diagnostic confirmation, and study group assignment.

Methods: Identifying women with PPD has involved funneling from a large population by screening and subsequent diagnostic confirmation. After giving birth, women give permission to be contacted for PPD screening. At 4-weeks postpartum, CARE nurses administer the Edinburgh Postnatal Depression Scale (EPDS) to identify depression symptoms. Eligible women have a home-visit to obtain informed consent and participate in a Structured Clinical Interview (SCID) to confirm or rule out PPD.  

Results: To date, 1,004 women have agreed to be screened for PPD. Of those, 803 women have been screened by a research nurse. Eighty-four (12.4%) women have been eligible for the study based on the EPDS screening.  Of those, 27 women have enrolled in the study and are active participants. Other eligible women declined participation for reasons including: return to work, difficulty scheduling home-visits, and lack of interest.  

Conclusions and Implications: Finding a hidden clinical population requires intensive effort to: access people at-risk, evaluate symptom severity, and, ideally, confirm presence of the problem. The CARE study approach involving self-report symptom screening followed by diagnostic interview for women with positive scores is an effective way to confirm PPD diagnostic status. Use of a SCID validates symptom severity, confirms diagnostic status, and rules out false positives. Strategies tested by the CARE Project can inform other studies involving identification of hidden clinical populations across a variety of locations and settings.  

See more of Women's Cardiac and Mental Health Issues
See more of The 17th International Nursing Research Congress Focusing on Evidence-Based Practice (19-22 July 2006)