Systematic Review of Barriers to and Facilitators of Screening for Postpartum Depression at Well-Child Visits in the United States

Objective: To identify and evaluate barriers to and facilitators of screening for postpartum depression (PPD) during well-child visits in the United States. Additionally, to describe prior work on PPD screening tool evaluation and outcomes from PPD screenings conducted within the well-child setting. Data Sources: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Five databases (Pub Med, PsycINFO, Web of Science, CINAHL, and Cochrane Library) were searched. Study Selection: Randomized controlled trials, case studies, cross-sectional studies, case–control studies, cohort studies, qualitative studies, and quasi-experimental studies conducted in the United States were included. The Standard Quality Assessment Criteria Tool (QualSyst) was used to assess the methodologic quality of each included study. Data Extraction: Sample, setting, methods, screening tools used, location of study setting, intervention, and salient findings were extracted and summarized for further analysis and synthesis. Data Synthesis: Quantitative studies were rated on 14 aspects, and qualitative studies were rated on 10 aspects, per QualSyst. Studies received a score of 2, 1, 0, or not applicable based on scoring criteria, with higher scores indicating greater methodologic quality. Conclusion: We found that barriers to PPD screening included concerns regarding time for screening, adequate training, and limited ability for referral. Facilitators of PPD screening included electronic prompts for providers, as well as tool availability and familiarity. Our results indicate that education and training about PPD screening in the pediatric setting are important next steps in addressing the rising concern of PPD in the United States.