Depression Screening Patterns for Women in Rural Health Clinics

Context: Rates and types of screening for depression in rural primary care practices are unknown.
Purpose: To identify rates of depression screening among rural women in a sample of rural health clinics (RHCs).
Methods: A chart review of 759 women's charts in 19 randomly selected RHCs across the nation. Data were collected from charts of female patients of rural primary care providers, using trained data collectors (inter-rater reliability .88 to .93). The Women's Primary Care Screening Form, designed by the authors, was used to collect demographic, health, and screening data. Data describing the characteristics of the clinics were collected using the National Rural Health Clinic Survey. Data regarding formal screening (validated instrument used) or informal (documentation of specific questions and answers regarding depression) in the previous 5 years were recorded.
Findings: Characteristics of participating clinics and demographics of the women were similar to published data. Formal screening was documented in 2.4% of patients' charts. Informal screening was documented in 33.2% of charts. Patients with a history of anxiety were more likely to be screened ( P < .001), and younger women were more likely to be screened than older women ( P < .001).
Conclusions: Primary care providers in RHCs use more informal than formal depression screening with their female patients. Providers are more likely to screen younger patients or patients with a diagnosis of anxiety.     

Latent class analysis of health,social, and behavioral profiles associated with psychological distress among pregnant and postpartum women during the COVID-19 pandemic in the United States

Background

There is a growing body of literature documenting negative mental health impacts from the COVID-19 pandemic. The purpose of this study was to identify risk and protective factors associated with mental health and well-being among pregnant and postpartum women during the pandemic.

Methods

This was a cross-sectional, anonymous online survey study distributed to pregnant and postpartum (within 6 months) women identified through electronic health records from two large healthcare systems in the Northeastern and Midwestern United States. Survey questions explored perinatal and postpartum experiences related to the pandemic, including social support, coping, and health care needs and access. Latent class analysis was performed to identify classes among 13 distinct health, social, and behavioral variables. Outcomes of depression, anxiety, and stress were examined using propensity-weighted regression modeling.

Results

Fit indices demonstrated a three-class solution as the best fitting model. Respondents (N = 616) from both regions comprised three classes, which significantly differed on sleep- and exercise-related health, social behaviors, and mental health: Higher Psychological Distress (31.8%), Moderate Psychological Distress (49.8%), and Lower Psychological Distress (18.4%). The largest discriminatory issue was support from one's social network. Significant differences in depression, anxiety, and stress severity scores were observed across these three classes. Reported need for mental health services was greater than reported access.

Conclusions

Mental health outcomes were largely predicted by the lack or presence of social support, which can inform public health decisions and measures to buffer the psychological impact of ongoing waves of the COVID-19 pandemic on pregnant and postpartum women. Targeted early intervention among those in higher distress categories may help improve maternal and child health.