Learning Objective #1: describe an efficient and systematic approach for identifying women at risk for depression in pregnancy and proactively intervene.

Learning Objective #2: describe an eight step approach to translate POP study findings into practice and policy.

---

Roughly one in 20 American women who are pregnant or have given birth in the past 12 months suffers from major depression. Prevalence is even higher among low-income and rural women. Depression during pregnancy is linked with tremendous personal suffering, greater maternal lifestyle risks, increased incidence of postpartum depression, and adverse birth outcomes. This suggests the importance to identify women at risk of depression early in pregnancy, yet they often go unrecognized and untreated. The aims of this presentation are to describe how POP study findings were translated into universal screening and referral of women at risk for depression in a rural prenatal clinic in the southeastern United States and the process of policy changes. Interviews were conducted with 324 pregnant women (African-American, 43% Caucasian, 31% Hispanic, 26%) of 16-28 weeks gestation from prenatal clinics to identify women at risk for depression. Standardized and reliable instruments were used including the Beck Depression Inventory-II (BDI-II). Thirty three percent of the women had BDI-II scores of ³16 and 14 (4.3%) expressed suicidal feelings. The research team met with clinic staff to implement a simple procedure to identify women at risk for depression using a decision tree that included two-item screening measures: “Over the past two weeks have you felt down, depressed, or hopeless?” “Over the past two weeks, have you felt little interest in doing things?” Women who screen positive complete the Edinburgh Postnatal Depression Scale (EPDS). Those who score ³12 are referred to the Maternity Care coordinator (MCC), offered a choice of a randomized clinical trial for depression in pregnancy, MCC care, or usual care; a plan for those at risk for suicide was developed. This may be an efficient and rapid way to identify and care for women at risk for depression in prenatal care settings.