Maternal Depression Screening in a Primary Pediatric Practice

Abstract

Problem: Perinatal depression is the most common complication of pregnancy. Despite best practice recommendations for standardized postpartum depression screenings in primary care, many pediatric practices do not screen leading to missed identification of potentially depressed postnatal mothers. Purpose: The purpose of this QI project is to answer the question, "Does postpartum depression screening utilizing the Edinburgh postpartum depression screen (EPDS) during infant well visits in the pediatric primary setting increase detection and referral rates of maternal depression?" Methods: The QI project was implemented from August 2020 to December 2020 at a pediatric primary practice in the mid-Atlantic region of Maryland. Preparation for the project included staff education on the incidence and impact of perinatal depression, EPDS administration and scoring, and the referral process for at-risk women. The EPDS was embedded as a required task in the electronic health record (EHR) for one through six-month well-infant visits. Mothers completed the paper screen and nursing staff entered the screen answers into the electronic health record. Providers reviewed the score of the screen and referred the women scoring in the at-risk range to community mental health resources. Well infant charts were reviewed weekly for the duration of the project and audited for screen completion, scores, provider reviews of results and documentation of provision of referral information. Results: Findings confirmed this screening intervention increased identification of at-risk mothers dramatically. Over the course of the project, 584 post-partum women presented to the office with their infant for well checks. Maternal screens for depression increased from zero documented screens to an average weekly rate of 95.9% (n = 560). Reviews of weekly screens averaged 92.7% (n + 521). The percentage of women scoring 10 or more on the EPDS during the project was 9.8% (n=55) which indicates at-risk for depression. Of those 55 women, 89% (n = 49) had documented provision of referral resources. Conclusions: Utilizing the Edinburgh Postnatal Depression Score tool leads to an improved identification process to assist mothers in receiving mental health treatment for depression.