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OBJECTIVES: Postpartum depression often remains unaddressed. Screening in well-child care (WCC) may improve early detection, promote maternal recovery, and reduce effects on child development. We assessed the effectiveness of screening for postpartum depression in WCC compared with care as usual (CAU) on outcomes at mother and child levels. METHODS: In a prospective, quasiexperimental, comparative design, mothers visiting Dutch WCC centers were exposed either to screening at 1, 3, and 6 months postpartum (n = 1843) or to CAU (n = 1246). Assessments were at 3 weeks (baseline), 9 months (the Mini International Neuropsychiatric Interview), and 12 months (the Spielberger State-Trait Anxiety Inventory, the Short-Form 12-Item Health Survey, the Maternal Self-Efficacy in the Nurturing Role questionnaire, and the Ages and Stages Questionnaire-Social Emotional) postpartum. RESULTS: Significantly fewer mothers in the intervention group were depressed at 9 months postpartum compared with the CAU group (0.6% vs 2.5% for major depression). The adjusted odds ratio was 0.28 (95% confidence interval, 0.12 to 0.63; Cohen's d, 0.70). For minor and major depression, figures were 3.0% vs 8.4%, and the adjusted odds ratio was 0.40 (95% confidence interval, 0.27 to 0.58; Cohen's d, 0.51). For parenting, anxiety symptoms, and mental health functioning, the intervention resulted in effect sizes ranging from 0.23 to 0.27. The effect on the child's socioemotional development was negligible. CONCLUSIONS: Implementation of screening for postpartum depression in WCC should be seriously considered given its positive effects on maternal mental health. The benefits of optimizing the trajectory after screening on maternal and child outcomes need further attention.

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Introduction Postpartum depression (PPD) is a mental health problem frequently experienced by mothers in the first year postpartum. Early detection and treatment can help to reduce its negative effect on the development of the newborn child. Well-baby care (WBC) is a promising screening setting for early detection of PPD. This systematic review investigates the evidence of the effectiveness of screening for PPD in WBC settings regarding mother and child outcomes. Methods Three electronic databases were searched: SCOPUS, PsychINFO and CINAHL. Two reviewers independently performed the study selection. Data extraction was based on a predefined data extraction form. Results Six studies were included; a quality assessment rated two studies as strong and four as weak. Four studies measuring outcomes at process level showed improvement in detection, referral and/or treatment rates. Four studies, including the two strong ones, where screening and enhanced care were combined, showed improvements in the Edinburgh Postnatal Depression Scale scores of the mothers in the intervention groups. No improvements were reported on other outcomes at parent level or at child level. At child level, weight was the only outcome that was measured. Discussion This review provides limited yet positive evidence for the value of screening for PPD in a WBC setting. The outcomes are comparable with studies on screening for PPD in general. The evidence that we found is very promising but the small number of available studies shows a need for additional high-quality studies, to strengthen the evidence regarding the potential benefits of screening in a WBC setting.

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RATIONALE, AIMS AND OBJECTIVES: In the Netherlands, evidence-based child abuse prevention (CAP) guidelines have been developed to support child health care professionals (CHPs) in recognizing and responding to suspected child abuse. The aim of this study was to identify factors related to characteristics of the guidelines, the user, the organization and the socio-political context that facilitate or impede adherence to the CAP guidelines. METHODS: Three semi-structured focus groups including 14 CHPs working in one large Dutch child health care organization were conducted in January and February 2012. Participants were asked questions about the dissemination of the guidelines, adherence to their key recommendations and factors that impeded or facilitated desired working practices. The interviews were audiotaped and transcribed. Impeding and facilitating factors were identified and classified. An innovation framework was used to guide the research. RESULTS: CHPs mentioned 24 factors that facilitated or impeded adherence to the CAP guidelines. Most of these factors were related to characteristics of the user. Familiarity with the content of the guidelines, a supportive working environment and good inter-agency cooperation were identified as facilitating factors. Impeding factors included lack of willingness of caregivers to cooperate, low self-efficacy and poor inter-agency cooperation. CONCLUSIONS: The results indicate that a broad variety of factors may influence CHPs' (non-)adherence to the CAP guidelines. Efforts to improve implementation of the guidelines should focus on improving familiarity with their contents, enhancing self-efficacy, promoting intra-agency cooperation, supporting professionals in dealing with uncooperative parents and improving inter-agency cooperation. Recommendations for future research are provided.

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