Automated depression screening in disadvantaged pregnant women in an urban obstetric clinic

Abstract

Objective: A promising means of screening for depression among high-risk perinatal women involves interactive voice response (IVR) technology in which patients self-enter data into a database using a touch tone telephone. Our aim was to test the feasibility of using IVR to screen for depression among low-income, urban pregnant patients and to solicit their preferences for treatment.

Methods: The study population included a convenience sample of English-speaking pregnant patients awaiting routine prenatal visits in an urban obstetric clinic. Consenting subjects used a phone in a private clinic room to complete an IVR version of the Edinburgh Postnatal Depression Scale (EPDS). Patients scoring in the "not depressed" range were branched to a closing message while those with mild to severe depressive symptoms were branched to additional automated questions about their treatment preferences.

Results: All 54 participants who consented to the study were able to complete the IVR phone session. More than 90% expressed willingness to complete IVR interviews as part of routine prenatal and postpartum care. Sixteen out of 54 participants (29.6%) scored in the moderate to severe range for depressive symptoms (EPDS >/= 12) which was consistent with a prior study in the same population using a validated paper-pencil screen. Only 12 out of 21 (57%) depressed subjects indicated a desire to speak with a health care provider about how they are feeling. The majority of these depressed subjects preferred to speak with a social worker about housing or financial problems (92%) or an obstetrician or midwife (83%), while a minority (42%) wanted to speak with a mental health professional.

Conclusions: This pilot study suggests that it is feasible to use an automated phone interview to screen for depression in low-income, urban pregnant women.