부산대학교 도서관

Objectives: To examine the rate of identification of symptoms of depression among mothers seen by social workers in a pediatric clinic and to identify factors associated with compliance with subsequent mental health referrals. Design: Prospective, uncontrolled, intervention study. Setting: Mothers in an urban pediatric primary care center. Measurements: Social workers rated mothers' degree of depressive symptomatology clinically, then administered the Center for Epidemiological Studies Depression scale (CES-D), a validated 20-item self-report symptom inventory. The social workers then referred mothers for mental health assessment and treatment, based on clinical judgement and CES-D results. Follow-up calls were completed 1-6 months later, to ascertain compliance with the referrals and assess maternal health beliefs related to her mental distress. Results: Of the 73 mothers enrolled, 67% (49/73) 'screened in' on the CES-D (i.e. scored >16). All but seven of these had been identified by the social workers prior to screening as showing at least 'minimal' depressive symptoms (sensitivity 86% with respect to the CES-D). However, only 21 had been identified as showing 'moderate or severe' symptoms (sensitivity 43%), a level of concern at which referral was more likely. Following scoring of the CES-D 44 mothers were referred to mental health services. Of these mothers, 59% (26/44) agreed to the referrals, but on follow-up only three mothers had actually attended the recommended visit. Conclusions: Identification by pediatric social workers of mothers with significant depressive symptoms is increased by systematic screening, but compliance with referrals for maternal mental health services is minimal. Further study is needed to define the determinants of compliance, and to devise more effective means of addressing maternal depression in the pediatric primary care setting.