This chapter covers the case study of Next Stop: Mum, a postpartum depression screening programme in Poland. The case study includes an assessment of Next Stop: Mum against the five best practice criteria, policy options to enhance performance and an assessment of its transferability to other OECD and EU27 countries.
Mental Health Promotion and Prevention
Best Practices in Public Health
Abstract
Description: Next Stop: Mum is a preventive programme based in northern Poland, that aims to screen for postpartum depression (PPD) in women throughout the last trimester of pregnancy and the first year after childbirth. The programme aims to train healthcare professionals (e.g. midwives and nurses) for PPD screening, inform women on PPD, screen women for the risk of PPD, and refer those with higher risks to psychological consultations as needed (up to three consultations at no cost for the higher-risk patients, covered by the programme). Conducted in 40 primary healthcare centres and in seven state hospitals for a duration of four years (2019-2023), the intervention covered over 21 600 women at mid-point in April 2022. The programme has provided better care to women with PPD through a better diagnosis and support pathway for psychological care, while raising awareness on the condition among healthcare professionals and the general public.
Best practice assessment:
|
Criteria |
Assessment |
|---|---|
|
Effectiveness |
Next Stop: Mum enables better identification and diagnosis of postpartum depression and nearly doubles the number of referrals to psychological support, with more than one in four women with subclinical or probable PPD receiving psychological consultations. The scale‑up of Next Stop: Mum in Poland is estimated to gain a cumulative total of about 3 960 disability-adjusted life years (DALYs) by 2050. Transferring Next Stop: Mum to OECD and EU27 countries is estimated to result in 0.83 and 0.74 DALYs gained per 100 000 people, on average per year between 2025 and 2050, respectively. |
|
Efficiency |
It is estimated that scaling up a PPD screening programme such as Next Stop: Mum – assuming the healthcare system covers psychological consultations beyond the first three‑ would be cost saving in 28% of countries studied and cost-effective in remaining countries. |
|
Equity |
The programme aims to provide cost-free screening to all women following childbirth and integrate screening into regular postpartum check-ups within primary healthcare settings. |
|
Evidence‑base |
An observational study was conducted on 7 345 patients who received the in-person screening programme to assess postpartum depression risk and evaluate the uptake of psychological consultations. Screening results were also assessed for 10 454 online self-screenings for postpartum depression. |
|
Extent of coverage |
Next Stop: Mum has reached about 5% of postpartum women in northern Poland with in-person screening. Another 5% have participated through online screening. |
Enhancement options: To enhance the effectiveness, particular attention should be paid to several implementation factors, such as prioritising anonymous screening, providing effective and time‑efficient referral pathways, conducting regular follow-up screening and identifying training gaps. To enhance the evidence‑base, cut-off points for diagnosis could be adapted to specific populations. To enhance equity, policymakers can pay particular attention to underprivileged and underserved groups and facilitate access to mental health care through information campaigns, telemedicine and the promotion of diversity in the healthcare workforce to facilitate trust between patients and their healthcare providers. To enhance extent of coverage, interventions should extend screening to mothers who are minors or that are passed the first postpartum year.
Transferability: Next Stop: Mum is broadly transferable to other settings within OECD and European countries. It is likely that PPD screening programmes receive political support due to existing mental health prevention policies and programmes in primary care settings.
Conclusion: The Next Stop: Mum approach has the potential to significantly reduce the incidence of PPD, as well as alleviate stigma around depression during maternity.
Next Stop: Mum (NSM) is a preventive programme in Poland that aims to promote peripartum and postpartum (PPD) screening in women throughout the last trimester of pregnancy and the first year after childbirth (Box 5.1). This programme fulfils the need for peripartum depression screening, as PPD screening became a national standard in January 2019 and was expanded in 2022 to include screening of peripartum depression for women in their last trimester of pregnancy. The new standard requires medical staff to monitor the mental health of pregnant and postpartum women. NSM aims to train healthcare professionals for PPD screening, inform women on PPD, screen women for the risk of PPD, and as needed, refer women with higher risk of PPD to a psychologist for further diagnosis, recommendations on next steps and eventually treatment (Chrzan-Dętkoś, Murawska and Walczak-Kozłowska, 2022[1]).
Postpartum depression (PPD) is a very common medical condition experienced by women after childbirth, consisting of the onset of depressive episodes characterised by despondency, emotional lability, feelings of guilt, loss of appetite, suicidal ideation, fatigue, irritability, poor concentration and memory, sleep disturbances as well as feelings of difficulty to cope with the child (Robertson et al., 2004[2]). PPD is often confused with baby blues that however only occurs for a very short period following childbirth, usually resolving after two weeks and for which treatment is not required (Woody et al., 2017[3]). If left untreated, PPD can last for seven months on average, and up to more than a year (Shorey et al., 2018[4]). PPD can also lead to additional health consequences for both mother and child (Sockol, Epperson and Barber, 2013[5]). Women experiencing PPD may, over time, develop social relationship problems, difficulties with breastfeeding, addictive behaviours, and overall poorer mental health (persistent depression, mood disorders, stress, anxiety and suicidal ideation) (Slomian et al., 2019[6]). These symptoms can reduce women’s quality of life, limit responsiveness to caregiving and impair mother-infant bonding. Consequences of PPD for infants and children can be significant. PPD has been associated with increased childhood morbidity and mortality, as well as lasting developmental consequences, particularly concerning cognitive development, social engagement, and emotional and behavioural regulation (Grace, Evindar and Stewart, 2003[7]; Sockol, Epperson and Barber, 2013[5]).
In high-income countries, between 10% and 20% of women experience PPD after giving birth, a rate that has been shown to be similar and even increased in low and middle‑income countries (Hansotte, Payne and Babich, 2017[8]; Wang et al., 2021[9]). These numbers are however very likely to be underestimated, as most countries have not yet implemented systematic screening of PPD and lack of awareness on PPD persists.
Based in the northern region of Poland, the NSM intervention was conducted in 40 primary healthcare centres and in seven state hospitals for a duration of four years (2019-2023) and was part of the National Health Policy Programme of the Ministry of Health, called “The Program of education and prevention of postpartum depression”. Managed by a consortium between the Copernicus hospital, the University of Gdansk and the Creative Women Foundation (Fundacja Twórczych Kobiet), the programme is a part of the “Operational Programme: Knowledge Education Development 2014 – 2020” co-financed by the European Social Fund. Across partner healthcare centres and hospitals, all women within their first year postpartum were offered to participate in the NSM screening programme.
PPD symptoms are assessed with the Edinburgh Postnatal Depression Scale (EPDS) questionnaire (Box 5.2), a tool recommended by the American Medical Association and one of the most used tools in perinatal care (Chrzan Dętkoś and Walczak Kozłowska, 2020[10]).
In the programme, Edinburgh Postnatal Depression Scale (EPDS) was used to screen women during the first year of postpartum. The EPDS tool provides users with a score that indicates the likelihood of experiencing PPD. Comprising 10 questions on well-being, the score ranges from 0 to 30 points, with higher scores indicating more pronounced symptoms of depression and a greater likelihood of PPD. Two cut-off points within this range are used to assess participants: scoring 12 points or more suggests ‘probable depression’, while scoring between 10 and 11 points suggests ‘subclinical, possible depression’. Scores are grouped into three categories:
“Normal Range” for scoring 0 to 9 points;
“Slightly Increased” for scoring 10 to 11 points, indicating subclinical PPD; and
“Increased” for scoring 12 points or above, indicating probable PPD. Questions within the EPDS touch upon feelings of unhappiness, stress, anxiety and sleep disturbances. Examples of questions include the following: “I have looked forward with enjoyment to things”, “I have blamed myself unnecessarily when things went wrong”, “I have been so unhappy that I have had difficulty sleeping”. Responses are structured across four levels of frequency (Cox, Holden and Sagovsky, 1987[11]).
This tool has been validated as appropriate for identifying probable PPD in pregnant and postpartum women, including postpartum adolescent mothers, and particularly accurate for anhedonia, anxiety, and depression (McBride et al., 2014[12]). However, further clinical assessment during screening is necessary to confirm results.
Healthcare professionals, such as midwives and nurses, are responsible for conducting Next Stop: Mum screening assessments during face‑to-face medical visits, primarily at the patients’ homes (e.g. postpartum visits, immunisation or medical appointments). In addition, the screening assessments are available via an internet-based platform, offering women the option to self-screen at no cost. Healthcare professionals appointed to the screening procedures obtain a 6‑hour training on perinatal mental health and screening methods, conducted by psychologists. These are preceded and followed by a knowledge test, to assess learning achievements and the effectiveness of the training.
Women with higher risk of PPD (scoring 10 or more points on the EPDS) are referred for up to three psychological consultations (45 minutes each) embedded in as part of the programme, at no cost. These consultations have a diagnostic function, not a curative one, and seek to further diagnose PPD. Based on needs, women are then referred to psychological therapy and pharmacotherapy if needed, a feature not included in the programme but that is covered by national health insurance in Poland (Narodowy Fundusz Zdrowia, 2021[13]). Among the women identified through screening as being at risk of probable or subclinical PPD, 26% attended at least one psychological consultation included in the programme.
This section analyses NSM against the five criteria within OECD’s Best Practice Identification Framework – Effectiveness, Efficiency, Equity, Evidence‑base and Extent of coverage (see Box 5.3 for a high-level assessment). Further details on the OECD Framework can be found in Annex A.
Effectiveness
Next Stop: Mum enables better identification and diagnosis of postpartum depression, and nearly doubles the number of referrals to psychological support, with more than one in four (26%) women with subclinical or probable PPD receiving psychological consultations.
Based on 7 345 in-person screenings, 7% of women were identified as having probable depression and 5% subclinical depression.
The scale-up of Next Stop: Mum in Poland is estimated to gain a cumulative total of about 3 960 disability-adjusted life years (DALYs) by 2050. Transferring Next Stop: Mum to OECD and EU27 countries is estimated to result in 0.83 and 0.74 DALYs gained per 100 000 people, on average per year between 2025 and 2050, respectively.
Efficiency
It is estimated that scaling up a PPD screening programme such as NSM – assuming the healthcare system covers psychological consultations beyond the first three- would be cost saving in 28% of countries studied and cost-effective in the remaining countries.
Equity
NSM aims to reach all women within their last trimester of pregnancy and first year after birth, as the intervention is implemented within primary healthcare settings, incorporating PPD screening within routine postpartum check-ups.
The programme effectively reaches rural women, with 23.7% of participants from rural areas, but only 2.3% of participants have primary education, highlighting limited reach among women with low education levels.
Evidence‑base
An observational study was conducted on 7 345 patients who received the in-person screening programme to assess postpartum depression risk and evaluate the uptake of psychological consultations. Screening results were also assessed for 10 454 online self-screenings for postpartum depression. The study measures improvements in healthcare staff’s knowledge on postpartum depression screening following training.
The study had a “strong” data collection method and performed moderately in the domains of “Selection Bias” and “Study Design”.
Extent of coverage
NSM has reached around 5% of postpartum women in the three northern regions of Poland with in-person screening. Another 5% has participated through online screening
Effectiveness
This section describes the impact NSM has had on the diagnosis of PPD in women following the first year after childbirth.
Improving the identification and diagnosis of women with PPD
NSM enables better identification and diagnosis of women experiencing PPD. An observational study was conducted on 7 345 postpartum women in their first year following childbirth, to assess their risk of PPD, track changes in risk of PPD over time, and measure the uptake of psychological consultations following referral. Data was gathered via EPDS questionnaires assessing PPD symptoms, which were completed by midwives and nurses during in-person postpartum medical visits as part of the first screening. A follow-up screening was carried out by telephone in the same group, three to nine months after the first screening, to re‑assess PPD symptoms (Chrzan-Dętkoś, Murawska and Walczak-Kozłowska, 2022[1]).
Results from the first screening show that, based on EPDS scores, 7.3% of women were identified as having probable PPD and 5% with subclinical PPD. In total, 12% of women included in the study had probable PPD or subclinical PPD, a result that is confirmed by recent estimations of PPD prevalence varying around 10 and 20% within high income countries (Wang et al., 2021[9]). A majority of women (88%) did not present elevated PPD symptoms. However, this trend changes among respondents who completed the survey online, where higher rates of probable or subclinical PPD were observed (Box 5.4).
Reassessments of PPD risk conducted through the follow-up screening indicate that PPD risk can fluctuate over time and can develop if left untreated. Among the 1 297 women who completed the follow-up screening three to nine months after initial screening, over 55% showed an increase in their EPDS scores and 16.5% identified as having probable PPD – up from 7.3% during the first screening (Chrzan-Dętkoś, Murawska and Walczak-Kozłowska, 2022[1]).
Data was also collected from 10 454 postpartum women who anonymously self-screened online on the programme’s website, using an EPDS questionnaire.
Results from the online self-screening vary greatly from those obtained through in-person assessments. EPDS scores of the participants of the online screening programme show that 77% of women were identified as having probable PPD and 8.3% as having subclinical PPD. These results are derived from self-screenings conducted independently by women from and outside of the programme, without the involvement of a midwife or a nurse. The absence of a healthcare professional might potentially prompt more genuine responses, as women might feel pressured and uncomfortable during the discussion. Conversely, the PPD prevalence obtained from online self-screenings may be overestimated due to the motivations driving individuals to undertake these screenings and their awareness of PPD.
Online screening has attracted much more interest than expected, with participation at mid-point being at almost twice the amount fixed at the start of the study (6 000 expected and 10 454 obtained at mid-point). The COVID‑19 crisis and related movement restrictions may have contributed to an increased use of the online tool (rather than the in-person screening) since the intervention lasted from 2019 to 2023.
Source: Chrzan-Dętkoś et al. (2022[1]), “‘Next Stop: Mum’: Evaluation of a Postpartum Depression Prevention Strategy in Poland”, https://doi.org/10.3390/ijerph191811731.
Reducing the risk of depression
Literature shows that PPD screening can increase awareness of mental health disorder and make women more likely to seek psychological support and receive it, and thereby, reduce symptoms and prevalence of depression. A systematic review based on six studies carried out on pregnant and postpartum women (up to eight weeks following birth) found that among women who underwent screening, the risk of depression is lowered by 18% to 59% (relative risks (RR) varying between 0.41 and 0.82) at follow-up (between 1.5 and 16 months across studies), compared to women who were not screened or did not have screening test results sent to their clinician. Likewise, the likelihood of achieving significant improvement or remission from depression is significantly increased for women who were screened, by between 21% and 182% compared to their non-screened counterparts (RR between 1.21 and 2.82) (O’Connor et al., 2016[14]).
In addition, there is evidence to suggest that early detection of PPD can be effective in the long term. Screening and preventing PPD cases can reduce the likelihood of future depressive episodes, as individuals who develop PPD are at higher risk of developing depressive symptoms again in the following five years (Castle, 2008[15]).
Impact of screening on referrals and consultation outcomes
Screening programmes for PPD have nearly doubled the number of referrals for psychological support, with more than one in four women with subclinical or probable PPD receiving psychological consultations. Of the women who had an increased EPDS score at direct assessments in NSM, 26% (about 300 women) have benefitted from the embedded psychological consultations – a rate nearly twice as high as the one expected at the start of the intervention. The referral rate may have been slightly underestimated, as the follow-up screenings revealed that 19.6% of the contacted women had not been informed of their EPDS results or of the possibility of seeing a psychologist. Previous studies support that PPD screening increases the likelihood of receiving referrals for psychological support by 16 times, compared to women who do not undergo any mental health assessment (Reilly et al., 2013[16]). Moreover, screening for depression led to decreases in depressive symptoms and improved mental health within the studied populations (Myers et al., 2013[17]).
Greater awareness of PPD in healthcare personnel
Training healthcare professionals on the assessment, treatment and management of antenatal and postnatal depression can improve their knowledge on these medical conditions. Healthcare providers participating in this intervention received a 6‑hour training conducted by psychologists on mental health in the perinatal period and screening methods. Among the 323 healthcare providers taking part in the training, a majority (88.2%) took the pre‑ and post-training tests. Of those having received the knowledge tests, nearly 80% raised their knowledge on this medical condition following the training sessions. Others presented either lower scores in their post-training test – around 10%- or unchanged results – around 12%.
The OECD’s Strategic Public Health Planning for non-communicable diseases (SPHeP-NCDs) microsimulation model was used to estimate the health and economic impact of expanding Next Stop: Mum across Poland and across all OECD and non-OECD European countries, assuming that 10% of the target population across the whole country would enter in a PPD screening programme and, when needed, receive three psychological consultations. Details on the model are in Annex A, while the list of model assumptions are in Annex 5.A at the end of this Chapter.
The rest of this section presents results for Poland, followed by remaining OECD and non-OECD European countries.
Poland
By enhancing diagnosis and referrals for psychological support, the implementation of NSM in Poland is estimated to gain a cumulative total of about 3 960 disability-adjusted life years (DALYs) by 2050 (Figure 5.1).
Note: The black lines represent 95% confidence intervals. Figures are discounted at a rate of 3%.
Source: OECD analyses based on the OECD SPHeP-NCDs model, 2025.
In gross terms, NSM is expected to have the greatest impact on depression and anxiety. As depression and anxiety are related, a PPD screening programme, such as NSM, can help reduce anxiety. Between 2025 and 2050, the number of depression and anxiety cases is estimated to fall by about 3 430 and 2 260 cases, respectively. No significant changes in the number of self-harm cases are observed within the same period.
OECD and EU countries
Transferring NSM to OECD and EU27 countries is estimated to result in 0.83 and 0.74 DALYs gained per 100 000 people, on average per year between 2025 and 2050 (ranging from 0.24 in Greece to 1.6 in Israel) (Figure 5.2).
Note: The black lines represent 95% confidence intervals.
Source: OECD analyses based on the OECD SPHeP-NCDs model, 2025.
In gross terms, NSM would have the greatest impact on depression and anxiety, with the intervention estimated to reduce the number of cases by about 389 660 and 131 980 cases in OECD countries, and by 120 330 and 40 750 cases in EU27 countries between 2025 and 2050, respectively. This represents about 0.03% and 0.01% of all cases of depression and anxiety, respectively, in the entire population across OECD and EU27countries.
Efficiency
This section presents a cost-effectiveness analysis of scaling up NSM and potential impacts on labour market outcomes assuming programme costs as reported in Annex 5.A at the end of this Chapter. The analysis assumes that 10% of target women would enter in the screening programme across the whole country and, when needed, receive up to three psychological consultations. Further psychological support and care, outside of the programme, are assumed to be covered by the healthcare system.
Table 5.1 provides information on intervention costs, total health expenditure savings and the cost per DALY gained in local currency for OECD and EU27 countries. Results show NSM is cost saving in 12 countries (28% of countries studied). For the remaining countries, NSM is cost-effective – given the cost per DALY is below the average cost-effectiveness threshold applied in European countries (i.e. EUR 50 000 based on (Vallejo-Torres et al., 2016[18])).
Note: * Cost per DALY gained is measured using total intervention costs less total health expenditure savings divided by total DALYs gained over the period 2025‑2050.
Source: OECD analyses based on the OECD SPHeP-NCDs model, 2025.
The reduction in cases of depression resulting from NSM has, in turn, an impact on labour market participation and productivity. It is estimated that NSM will contribute to a reduction in the incidence of depression among new mothers, thereby encouraging increased employment and reduced absenteeism and presenteeism among women as they resume their positions in the workforce. Converting these labour market outputs into full-time equivalent (FTE) workers, it is estimated that OECD and EU27 countries will gain 0.26 and 0.28 FTE per 100 000 working age people per year between 2025 and 2050, respectively (Figure 5.3). In monetary terms, this translates into average per capita increase in labour market production of EUR 0.13 for OECD countries and EUR 0.12 for EU27 countries (Figure 5.3).
Note: The black lines represent 95% confidence intervals.
Source: OECD analyses based on the OECD SPHeP-NCDs model, 2025.
Equity
At a high level, NSM aims to raise awareness and promote PPD screening for all women, regardless of income or place of residence. Notably, the rural population is well represented, with 23.7% of total study participants living in rural areas. Yet, there are sociodemographic differences in the uptake of the screening programme.
More vulnerable sociodemographic groups are found to be at higher risk of developing PPD and less likely to seek psychological support. PPD is more prevalent in minority and disadvantaged groups. Women with lower sociodemographic background, women of young age and ethnic minorities are disproportionately more affected by the challenges of the perinatal period (Pilav et al., 2022[19]). These challenges are exacerbated by a more limited access to healthcare and poorer treatment of mental illness after child delivery, which in turn can lead to an under-representativeness of these population groups in the literature and in the intervention’s participation, and a possible underestimation of PPD prevalence (Kozhimannil, 2011[20]). Evidence from the Next Stop Mum intervention consistently points to these inequalities. Women with a higher gestational age at birth, higher income and education levels were more likely to attend the psychologist consultation embedded in the programme (Chrzan-Dętkoś, Murawska and Łockiewicz, 2025[21]). The positive association with education can however be partially attributable to the fact that less educated women were less likely to participate in the screening programme. Merely 2.3% of participating women had primary education level, compared to 11.7% in the general population in Poland (Główny Urząd Statystyczny, 2022[22]).
The intervention can help reducing barriers to access to mental health support. Barriers that prevent women from attending mental health care include, for instance, issues with logistics, transportation, childcare, time, health insurance and financial hurdles. The study revealed that women who did not attend the consultations embedded in the programme were more likely to have experienced an at-risk pregnancy and were less likely to have a higher education level, compared to those who attended the consultation. NSM offers the option of attending consultations remotely, which may contribute to reducing barriers to access to mental health support and thereby narrowing inequalities in access.
Evidence‑based
The evidence on NSM is mainly collected from a study carried out in the northern regions of Poland (Chrzan-Dętkoś, Murawska and Walczak-Kozłowska, 2022[1]). This study includes a total of 21 692 participants, for which the risk of depression was assessed using the EPDS tool. This tool has been validated as a reliable and accurate screening method for perinatal and postpartum depression (McBride et al., 2014[12]) (Levis et al., 2020[23]).
The Quality Assessment Tool for Quantitative Studies assesses the quality of evidence as strong in the domain of “Data collection methods”, moderate in the domains of “Selection Bias” and “Study Design” and weak in “Blinding” (see Table 5.2) (Effective Public Health Practice Project, 1998[24]).
Source: Effective Public Health Practice Project (1998), “Quality assessment tool for quantitative studies”, https://www.nccmt.ca/knowledge-repositories/search/14; Chrzan-Dętkoś et al. (2022), “‘Next Stop: Mum’: Evaluation of a Postpartum Depression Prevention Strategy in Poland”, https://doi.org/10.3390/ijerph191811731.
Extent of coverage
The NSM intervention spans four years (2019-2023) and currently covers three years of data collection (2019-2022) from direct assessments conducted by nurses and midwives from 40 primary healthcare centres and seven state hospitals, as well as online assessments. At the project’s mid-point analysis in 2022, a total of 21 692 women were covered by the programme (i.e. being screened for PPD either in-person or online), with the inclusion criteria of being within their last trimester of pregnancy or the first year postpartum. Out of this total number, 11 238 (52%) of women were screened in-person (direct screening), of whom 7 345 were included in the study for analysis.
Based on yearly national statistics, the three northern regions where the study took place (Pomorskie, Kujawsko-Pomorskie, Warmińsko-Mazurskie) have an estimated 223 544 women within their first year postpartum between 2019 and 2022 (Główny Urząd Statystyczny (Statistics Poland), n.d.[25]). The programme therefore has reached about 5% of postpartum women in northern Poland with in-person screening, and another 5% have participated through online screening.
This section outlines policy options to enhance the performance of the Next Stop: Mum approach against the five best practice criteria.
Enhancing effectiveness
Anonymous screening
Strengthening the anonymity feature of the programme could enhance its effectiveness. Online self-assessments are effective in providing patients with anonymity and intimacy when completing the EPDS or any other screening tool for depression. Evidence show that online screenings result in greater self-disclosure due to the privacy they offer, in the absence of social pressure, feelings of discomfort, stigma and taboo (Rains, 2014[26]) (Moore, Drey and Ayers, 2020[27]). In contrast, in-person screenings present limitations, such as an under-detection of cases of depression which can lead to delayed care and worsening of symptoms (Lim et al., 2018[28]). To enhance the effectiveness of in-person screenings, the NSM programme could aim to reassure women about the anonymity of their results and the confidentiality of their consultations. It could also seek to integrate the online screening tool seamlessly into in-person visits.
Increasing referral uptake
Increasing the uptake of referral consultation is essential to improve the effectiveness of the programme. Referral uptake within the NSM programme remained low, as nearly 8% of the referred patients enrolled in at least one psychological consultation embedded in the programme, and over 80% of them took part in all three consultations. There are possible options to improve referral uptake. First, enhancing communication with patients on the obtained results could help to improve referral uptake by patients who are at risk of PPD. Second, the possibility to refer patients should be given to various healthcare providers (such as general practitioners, family physicians and gynaecologists), so as to enable different referral pathways. Third, improving referral pathways that would minimise waiting time and improve access to psychological consultations would also improve referral uptake. This can be done by: 1) establishing standard guidelines on screening and referral to avoid the use of non-standardised methods, 2) creating perinatal mental health services, 3) organising medical networks within local areas that associate hospitals and healthcare centres to psychological and psychiatric units and professionals, 4) creating free‑of-charge maternal mental health hotlines for confidential support, as was developed in the United States (U.S. Health and Human Services Department, 2022[29]).
Regular follow-up screening
To further enhance the effectiveness, it is advisable to make regular follow-up screenings at various points in the postpartum period, as PPD can develop or worsen if left untreated. Relapse remains a concern within and beyond the first year postpartum, as illustrated by the increase in EPDS scores observed in the study’s follow-up PPD assessments (Chrzan Dętkoś and Walczak Kozłowska, 2020[10]). These results are consistent with previous findings that show increasing PPD rates during the second and third trimesters after birth (Bennett et al., 2004[30]). These findings underscore the importance of screening for PPD at various points in the postpartum period.
Improving professional training
Improving professional training is essential to improve screening, thereby enhancing the effectiveness of the programme. As outlined in the current national standard of screening perinatal mental health disorders in Poland (Chrzan Dętkoś and Walczak Kozłowska, 2020[10]), a previous study found that only 20% of midwives felt educationally prepared to screen and manage women with perinatal depression. This suggests that there is scope for improvement and standardisation of health professional training, guidelines for screening, referral, and treatment for PPD. Key steps forward would be to generalise the training of healthcare professionals on PPD diagnostic tools, such as EPDS, and to seek to improve the quality of training. Training of healthcare providers on the use of the EPDS screening tool is highly recommended, to limit the use of non-standardised methods and the misuse of the tool (De Figueiredo et al., 2015[31]). Evaluating professional training and learning, through systematic assessments and professional follow-ups, could help to optimise the quality of training, and create training content that meets the needs. Lastly, regular updates for educational purposes, through newsletters or other communication pathways, could help medical professionals stay up to date with information on PPD.
Enhancing efficiency
Policies that boost effectiveness will have a positive impact on efficiency (see Enhancing effectiveness).
Enhancing equity
NSM targets the whole community. However, vulnerable groups may experience greater barriers to accessing perinatal healthcare and psychological support, such as systemic healthcare barriers and personal barriers. To optimise access to qualitative perinatal healthcare and psychological support, the programme could consider the following enhancement options:
A particular attention could be directed towards underprivileged communities, including migrants, refugees and groups with lower socio-economic status. These communities are more at risk of developing depressive symptoms and encounter further barriers to access perinatal psychological support. Strategies of stigma reduction, cultural and financial adaptation, and enabling flexible scheduling options can help to facilitate access to the programme (Iturralde et al., 2021[32]).
The diversification of healthcare providers that work with pregnant and postpartum women would increase racial and ethnic representativeness and foster greater trust between patients and caregivers.
Increasing the provision of teleconsultations could alleviate issues related to time and geographic access (especially for those living in underserved areas), thereby improving access to perinatal psychological support.
Communication and information campaigns on PPD could help destigmatise mental health disorders and better equip pregnant women with the necessary information to identify symptoms and seek help. Targeted communication directed towards vulnerable groups is key to increase the level of health literacy on maternal mental health, which in term can enhance adherence to care pathways in these groups, thereby reducing health inequalities.
Enhancing the evidence‑base
Strengthening the quality of evidence using a robust study design. The current evidence on PPD reduction following screening and psychological care is derived from a systematic review (O’Connor et al., 2016[14]), whereas the NSM study relies solely on observational data on the prevalence of PPD and the uptake of psychological sessions, in absence of a control group. To strengthen the evidence base, it is important to evaluate the programme through a randomised study using a control group. A stronger methodology would enhance the evaluation of how PPD screening for postpartum women impacts the uptake of psychological consultations and the subsequent reduction in PPD risk. In the case of NSM, a randomised controlled trial may pose ethical concerns regarding the denial to access to PPD screening for a population with high risks of depression. Alternatives may be worth considering, such as using statistical methods and econometric tools to allow for causal inference in observational settings (e.g. matching). Quasi‑experimental studies, such as pre‑post cohort analytic could be considered. These studies would compare psychological consultation uptake in previous settings where PPD screening was not mandatory to those where it has been implemented.
Enhancing extent of coverage
Broadening the post- and prenatal screening period can help to enhance the extend of coverage. NSM covers postpartum women within their last trimester of pregnancy and first year following birth, within three regions in Poland. However, the period for developing depressive symptoms is broader, starting from pregnancy and potentially persisting a few years after childbirth (National Institute of Mental Health, 2023[33]). Around a quarter of women are estimated to have elevated symptoms of depression up to three years after childbirth (Putnick et al., 2020[34]). Data collected about the use of the online questionnaire indicates a need that extends beyond this timeframe. Although the NSM programme was destined for women within their first postpartum year, anyone was able to access the online questionnaire. Data shows that both women beyond the initial year after childbirth and men undertook the self-screening diagnosis on the website (Chrzan-Dętkoś, Murawska and Walczak-Kozłowska, 2022[1]). It is therefore highly recommended that women in their pregnancy and women having exceeded the first year postpartum may be included in screening schemes and referral pathways for further psychological support. Moreover, screening should be authorised for mothers aged under 18, for whom PPD has been found to be more prevalent (Sangsawang, Wacharasin and Sangsawang, 2019[35]).
This section explores the transferability of NSM and is broken into three components: 1) an examination of previous transfers; 2) a transferability assessment using publicly available data; and 3) additional considerations for policymakers interested in transferring NSM.
Previous transfers
The NSM programme, as described above, is based exclusively in Poland. However, screening for PPD has also been implemented in many other European and OECD countries, at both national and local levels. Routine screening for depression and mental health disorders in pregnant and postpartum women has been included in national guidelines for perinatal healthcare in other OECD countries, such as Australia, New Zealand, Ireland, and Italy. However, there are still gaps in implementation that need to be addressed to achieve optimal coverage at national levels.
Transferability assessment
This section outlines the methodological framework to assess transferability followed by analysis results.
Methodological framework
A few indicators to assess the transferability of NSM were identified (see Table 5.2). Indicators were drawn from international databases and surveys to maximise coverage across OECD and non-OECD European countries. Please note, the assessment is intentionally high level given the availability of public data covering OECD and non-OECD European countries.
Results
Results from the transferability assessment using publicly available data are summarised below (see Table 5.3 for results at the country level):
The analysis shows that the number of midwives is amongst the highest in Poland, with 0.75 practicing midwives per 1 000 population.
In terms of access to mental healthcare, 4% of the Polish population reported consulting mental healthcare or rehabilitative care professionals, compared to around 6% on average across OECD countries.
The prevalence of digital tool usage and digital proficiency varies across OECD countries, with generally 40% to 80% of individuals having basic digital skills and utilising the internet for health-related information – with an average around 60%. In Poland specifically, approximately 44% of the population has basic digital skills, while over 50% use the internet for health-related inquiries.
A vast majority of countries have national strategies to guide implementation of mental health policies (81%) and policies that improve mental health awareness and literacy, indicating that NSM would likely receive political support among potential transfer countries. Most countries also have mental health prevention policies within primary healthcare settings and policies that integrate digital technologies into mental health delivery.
Spending on prevention across OECD countries is typically higher than in Poland (i.e. only 3 of the 39 countries analysed reported spending less on prevention than Poland). Poland’s primary healthcare spending ranks near that of the OECD average, with 1.1% of GDP versus nearly 1.4% in OECD countries on average.
A darker shade indicates Next Stop: Mum is more suitable for transferral in that particular country
Note: n/a = no available data. The shades of blue represent the distance each country is from the country in which the intervention currently operates, with a darker shade indicating greater transfer potential based on that particular indicator (see Annex A for further methodological details). The full names and details of the indicators can be found in Table 5.2.
Source: Eurostat (2023[36]), Share of individuals having at least basic digital skills (%), https://ec.europa.eu/eurostat/databrowser/view/sdg_04_70/default/table (accessed on 24 February 2025); Eurostat (2022[37]), Self-reported consultations of mental healthcare or rehabilitative care professionals by sex, age and educational attainment level, https://doi.org/10.2908/HLTH_EHIS_AM6E (accessed on 7 April 2024); Eurostat (2023[38]), Individuals using the internet for seeking health-related information, https://ec.europa.eu/eurostat/databrowser/view/tin00101/default/table?lang=en (accessed on 24 February 2025); OECD (2022[39]), OECD Data Explorer - Practicing midwives per 1 000 population, https://data-explorer.oecd.org/s/2xf; OECD/WHO Regional Office for Europe (2023[40]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to enable mental health promotion, prevention and treatment of mental health conditions in primary health care; OECD/WHO Regional Office for Europe (2023[41]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to improve mental health awareness and literacy; OECD/WHO Regional Office for Europe (2023[42]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes for integrating digital technologies and tools into mental health service delivery; OECD/WHO Regional Office for Europe (2023[43]), Mental Health Systems Capacity Questionnaire 2023 - Strategy or action plan that guide implementation of the mental health policy.
To help consolidate findings from the transferability assessment above, countries have been clustered into one of three groups, based on indicators reported in Table 5.2. Countries in clusters with more positive values have the greatest transfer potential. While this analysis provides a high-level overview assuming some simplifications, it is important to note that countries in lower-scoring clusters may also have the capacity to adopt the intervention successfully. For further details on the methodological approach used, please refer to Annex A.
Key findings from each of the clusters are below with further details in Figure 5.4 and Table 5.4:
Countries in cluster one, have sector specific and political arrangements in place to transfer NSM. These should however ensure that the programme is affordable and addresses mental health needs within the population. This group includes 17 countries.
Countries in cluster two have populational and economic arrangements to support NSM. However, prior to transferring the intervention, these countries may wish to consider ensuring that the healthcare sector is ready to implement the programme, and that it aligns with political priorities. This group includes 16 countries.
Remaining countries are in cluster three. These should consider whether the intervention aligns with political priorities and might benefit from undertaking further analyses to ensure NSM is affordable and can be implemented within existing healthcare infrastructures. This group includes six countries.
Note: Bar charts show percentage difference between cluster mean and dataset mean, for each indicator.
Source: OECD analysis.
Note: Due to high levels of missing data, the following countries were omitted from the analysis: Canada, Chile, New Zealand, the United States.
Source: OECD analysis.
New indicators to assess transferability
Data from publicly available datasets alone is not ideal to assess the transferability of public health interventions. Box 5.5 outlines several new indicators policymakers could consider before transferring NSM.
In addition to the indicators within the transferability assessment, policymakers are encouraged to collect information for the following indicators:
Population context
What is the maternal mortality rate related to perinatal depression?
What are the main barriers to access perinatal mental health support?
What is the population’s attitude towards PPD screening?
Sector specific context
Is PPD screening embedded in the usual perinatal care?
Is there training on perinatal depression in midwifery and nursing schools?
Are there any guidelines about PPD screening?
How do the rates of midwives and psychologists per 1 000 inhabitants compare between rural and urban areas?
What is professional’s attitude (nurses, midwifes, GP, therapists) towards PPD screening?
Political context
Does a national plan exist to ensure systematic screening for postpartum and perinatal depression?
Economic context
Is there a dedicated budget for perinatal mental health?
Next Stop: Mum is a mental health prevention programme targeting women within their last trimester of pregnancy and first year postpartum in Poland. The purpose of the programme is to train healthcare professionals (e.g. midwives and nurses) for PPD screening, inform women on PPD, screen women for the risk of PPD, and refer those with higher risks to psychological consultations as needed.
NSM has the potential to reduce the repercussions of PPD that are overlooked or not treated. NSM focusses on screening PPD and providing psychological referral as needed, thereby reducing the risk of depression in postpartum. The programme also reduces the stigma around depression during the perinatal period. It is estimated that scaling up a PPD screening programme such as NSM would be cost saving in 28% of countries studied and cost-effective in remaining countries.
The programme has a positive impact on many best practice criteria; however, further enhancements are possible. For instance, particular attention could be drawn to mental health care provision for vulnerable populations such as people living in underserved areas, ethnic minority groups, including migrants and refugees, as well as underage women.
NSM is highly transferable in 17 out of 39 EU and OECD countries, and intermediately transferable to 16 of them. The transferability analysis using clustering suggests that the reform can be readily transferred to nearly 44% of countries, which were included in the cluster of highest transferability. However, all countries have the opportunity to tailor national screening strategies for perinatal depression according to their specific needs, resources and contexts.
Next steps for policymakers and funding agencies to enhance screening for perinatal depression are listed below:
Ensure effective nationwide implementation of screening for perinatal and postpartum depression, provide comprehensive training on perinatal mental health to healthcare professionals, and establish clear guidelines on screening tools and referral pathways.
Enhance support for policies and strategies that promote mental health in the perinatal period, with a particular focus on underprivileged and underserved communities.
Enable easy referral pathways and access to psychological support for individuals suffering from postpartum and perinatal depression.
Promote “lessons learnt” from regions within Poland where the intervention has been carried out, as well as from countries where PPD screening has been implemented.
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A systematic review based on six studies found that PPD screening reduces the risk of depression by 18% to 59% at follow-up (between 1.5 and 16 months across studies) compared to controls (no screening or no screening test results) (O’Connor et al., 2016[14]). And, PPD screening programmes combined with support were associated with an increase of 33% in achieving a reduction of at least 5 points in PHQ‑9 scores at one year follow up (Yawn et al., 2012[46]).
The reduction in PHQ score reaches a maximum effect at start of the intervention, with a maintained effect up to 12 months, after which it was assumed to return to 0 by 24 months.
All adult women of reproductive age (15 to 49) within their first year postpartum are targeted by the intervention.
Based on data from the NSM and national statistics on birth rates (Chrzan-Dętkoś, Murawska and Walczak-Kozłowska, 2022[1]; Główny Urząd Statystyczny (Statistics Poland), n.d.[25]), it is estimated that about 5% of eligible patients get referred to the in-person screening. When modelling the scale‑up of the intervention, it is estimated that the coverage doubles and the intervention covers 10% of the eligible patients.
The total cost of the intervention is equivalent to about EUR 506 207 (PLN 2 238 291) for a duration of three years, based on the project’s budget summary. These costs include project staff expenses, contracted, legal and administrative services, up to three follow-up psychological consultations for women screened with high risk of PPD, fixed assets (e.g. information technology and office equipment), website development, as well as informational and educational material. Over the three‑year period, around 5% (11 238) women in perinatal period received the in-person screening intervention and about 300 women received at least one follow-up psychological visit. It is estimated that scaling up NSM to double the intervention coverage has a yearly average cost of EUR 0.06 per capita, based on the population size in the three regions where the programme was implemented.