A randomized controlled trial of screening for maternal depression with a clinical decision support system

Abstract

Objective: To determine if automated screening and just in time delivery of testing and referral materials at the point of care promotes universal screening referral rates for maternal depression.

Methods: The Child Health Improvement through Computer Automation (CHICA) system is a decision support and electronic medical record system used in our pediatric clinics. All families of patients up to 15 months of age seen between October 2007 and July 2009 were randomized to one of three groups: (1) screening questions printed on prescreener forms (PSF) completed by mothers in the waiting room with physician alerts for positive screens, (2) everything in (1) plus 'just in time' (JIT) printed materials to aid physicians, and (3) a control group where physicians were simply reminded to screen on printed physician worksheets.

Results: The main outcome of interest was whether physicians suspected a diagnosis of maternal depression and referred a mother for assistance. This occurred significantly more often in both the PSF (2.4%) and JIT groups (2.4%) than in the control group (1.2%) (OR 2.06, 95% CI 1.08 to 3.93). Compared to the control group, more mothers were noted to have depressed mood in the PSF (OR 7.93, 95% CI 4.51 to 13.96) and JIT groups (OR 8.10, 95% CI 4.61 to 14.25). Similarly, compared to the control group, more mothers had signs of anhedonia in the PSF (OR 12.58, 95% CI 5.03 to 31.46) and JIT groups (OR 13.03, 95% CI 5.21 to 32.54).

Conclusions: Clinical decision support systems like CHICA can improve the screening of maternal depression.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: one author (PGB) had financial support from the NIH/NLM for the submitted work, and no other authors had relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1

CHICA's maternal depression screening algorithm. CHICA, The Child Health Improvement through Computer Automation system; MD, medical doctor; PHQ-9, nine-item Patient Health Questionnaire.

Figure 2

Example of a pre-screening form with maternal depression questions.

Figure 3

(A) Example of the provider worksheet with maternal depression prompts for the control group. (B) Example of the provider worksheet with maternal depression prompts for the PSF and JIT groups (note that in the PSF group, the fourth box read ‘Counseled’ and made no mention of a handout).