Evaluation of the effectiveness of a screening program as compared to usual care in identifying patients with post-partum depression: a cohort study of 20,448 births in Bizkaia (Spain)

J Affect Disord. 2026 Mar 11:121609. doi: 10.1016/j.jad.2026.121609. Online ahead of print.

ABSTRACT

BACKGROUND: Postpartum depression (PPD) is frequently underdiagnosed despite its significant impact on maternal and infant health. This study evaluated the effectiveness of a population-based screening program in increasing PPD detection and reducing time to diagnosis compared with usual care in a universal public healthcare setting.

METHODS: A retrospective cohort study included 19,234 women corresponding to 20,448 births, delivered between January 2020 and June 2023 across several healthcare areas in Bizkaia (Spain). We compared outcomes from the health area with a screening program implemented (300,000 inhabitants) with those from areas without such program (800,000 inhabitants) in terms of PPD detection and time to diagnosis. Univariate Cox proportional hazards models and multivariate Cox regression models were used in the analyses.

RESULTS: PPD raw prevalence was higher among screened women (7.4%) from the intervention area than among unscreened women in the intervention area (4.1%) or in non-intervention areas (4.4%). Screening independently increased the likelihood of PPD identification (HR 1.26, p = 0.001) comparing intervention with non-intervention areas. Screened women were diagnosed earlier (median 105 days) than unscreened groups from the intervention area or the non-intervention areas (180-215 days). Additional independent predictors included Spanish origin, low socioeconomic status, cesarean delivery and very low birth weight (<1500 g). There were no differences regarding psychotropic prescription rates across the three groups (Intervention/screened, intervention/unscreened, non-intervention).

CONCLUSIONS: Systematic screening significantly improves detection and accelerates diagnosis of PPD beyond usual care. Nonetheless, our findings also highlight at-risk subgroups warranting targeted follow-up, and possible access inequalities related to foreign origin.

PMID:41825749 | DOI:10.1016/j.jad.2026.121609