Uptake of referrals for women with positive perinatal depression screening results and the effectiveness of interventions to increase uptake: a systematic review and meta-analysis

Abstract

Aims Perinatal depression threatens the health of maternal women and their offspring. Although screening programs for perinatal depression exist, non-uptake of referral to further mental health care after screening reduces the utility of these programs. Uptake rates among women with positive screening varied widely across studies and little is known about how to improve the uptake rate. This study aimed to systematically review the available evidence on uptake rates, estimate the pooled rate, identify interventions to improve uptake of referral and explore the effectiveness of those interventions. Methods This systematic review has been registered in PROSPERO (registration number: CRD42019138095). We searched Pubmed, Web of Science, Cochrane Library, Ovid, Embase, CNKI, Wanfang Database and VIP Databases from database inception to January 13, 2019 and scanned reference lists of relevant researches for studies published in English or Chinese. Studies providing information on uptake rate and/or effectiveness of interventions on uptake of referral were eligible for inclusion. Studies were excluded if they did not report the details of the referral process or did not provide exact uptake rate. Data provided by observational studies and quasi-experimental studies were used to estimate the pooled uptake rate through meta-analysis. We also performed meta-regression and subgroup analyses to explore the potential source of heterogeneity. To evaluate the effectiveness of interventions, we conducted descriptive analyses instead of meta-analyses since there was only one randomised controlled trial (RCT). Results Of 2302 records identified, 41 studies were eligible for inclusion, including 39 observational studies (n = 9337), one quasi-experimental study (n = 43) and one RCT (n = 555). All but two studies were conducted in high-income countries. The uptake rates reported by included studies varied widely and the pooled uptake rate of referral was 43% (95% confidence intervals [CI] 35–50%) by a random-effect model. Meta-regression and subgroup analyses both showed that referral to on-site assessment or treatment (60%, 95% CI 51–69%) had a significantly higher uptake rate than referral to mental health service (32%, 95% CI 23–41%) (odds ratio 1.31, 95% CI 1.13–1.52). The included RCT showed that the referral intervention significantly improved the uptake rate (p ＜ 0.01). Conclusions Almost three-fifths of women with positive screening results do not take up the referral offers after perinatal depression screening. Referral to on-site assessment and treatment may improve uptake of referral, but the quality of evidence on interventions to increase uptake was weak. More robust studies are needed, especially in low-and middle-income countries.

Chinese Women’s Acceptance and Uptake of Referral after Screening for Perinatal Depression

“…After we uncovered this low uptake of referral, we published a systematic review on the issue of uptake of referral [14]. In that review, we found that the top reasons were lack of time and perception that mood had improved [31][32][33][34][35][36][37].…”

“…All 17 studies included in this review were conducted in economically developed countries, with 13 from the United States [13]. We updated this review and found 41 studies related to the acceptance of referral after PND screening [14]. Only two were not conducted in high-income countries; they were from South Africa and Turkey.…”

Improving access to perinatal mental health services: the value of on-site resources

“…Specific factors that serve as barriers to care include referral to services at another physical location and care received outside of the maternal and infant care home. 16,17 Our efforts to place mental health counselors within the clinics in which women received their prenatal care eliminates these barriers. The absence of identifiable demographic and outcome factors in those with unsuccessful evaluation precludes our ability to identify those women at risk of not being evaluated.…”

Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study

“…They reported they often did not complete questionnaires nor want referrals for service. A systematic review by our team has identified similar issues in many countries [ 24 ] and there is a serious lack of data on perinatal depression screening and referral patterns in China or among Chinese members of other societies. Next steps needed include determining culturally attuned ways to deliver perinatal depression care to Chinese immigrants.…”