Predictors of referrals and depression outcomes among obstetrics and gynecology patients with positive depression screens.

Abstract

Introduction:Little is known about the care provided following positive depression screens in obstetrics and gynecology (Ob/Gyn) patients. Method: This study evaluated documented care plans and outcomes for 445 Ob/Gyn patients with positive depression screens between January 2018 and December 2020. Logistic regression models were estimated to identify predictors of changes in documented care plans and to test if a documented plan was associated with a reduction in depression severity in 6 months. Results: The sample consisted of 445 patients who were on average 35.5 (SD = 12.8) years; 206 (46.3%) were White and 178 (40.0%) were Black. A total of 64 (14.4%) had a depression care plan documenting antidepressant initiation or change and/or psychotherapy referral. Relative to those aged 18-29, patients 40 or older had approximately 60% lower odds of a documented care plan change (OR = 0.394; p , .05). Relative to those seen by nurses, patients seen by physicians had approximately 70% lower odds of having treatment change (OR = 0.282; p , .05). Patients with a depression care plan documented had approximately 2.7 times higher odds of achieving 50% or more reduction in their Patient Health Questionnaire-9 depression severity score than those without a documented plan (OR = 2.685; p = .009). Discussion: While most patients did not experience an initiation or change in their depression care plan on the same day as their positive screen, those patients with a plan documented showed significantly more improvement than those who did not. Standardized recommendations may improve depression outcomes among patients with positive depression screens. Public Significance StatementDepression screening is now standard practice in obstetrics and gynecology practices. Yet little is known about what care is actually received by patients after they screen positive for depression. This study found although patients who received care for depression following a positive depression screen showed improvement in their depression, most patients did not have documented depression treatment in their electronic health records following a positive screen.This article was published Online First September 28, 2023.Ellen Poleshuck https://orcid.org/0000-0002-2961-4159There was no funding used for this study. The authors would like to thank LouAnne Jeager and Todd Reynolds for their assistance in retrieving the electronic health record data. The authors would also like to thank Stephanie Bruder, MHA, MS for her assistance with formatting. The authors have no conflict of interests to declare.Ellen Poleshuck served as lead for conceptualization, supervision, and writing-original draft and contributed equally to methodology. Marika Toscano served in a supporting role for conceptualization and writing-review and editing. Keisha Bell served in a supporting role for conceptualization and writing-review and editing. Tziporah Rosenberg served in a supporting role for methodology and writing-review and editing. Ellen Tourtelot served in a supporting role for ...