Postpartum Depression Screening in the Pediatric Emergency Department

Abstract

Problem: The Pediatric Emergency Department at an academic tertiary care center does not routinely screen mothers for postpartum depression, despite 60% of Maryland mothers reporting signs and symptoms, with only 8% receiving formal diagnosis and treatment. Undiagnosed, thus untreated postpartum depression has negative impacts not only for the mother but also for children which can last from infancy through adulthood, and ultimately lead to more emergency department visits for both the mother and child. Purpose: The purpose of this quality improvement project was to implement postpartum depression screening using the Edinburgh Postnatal Depression Scale (EPDS) to mothers of children under 12 months of age who present to the pediatric emergency department and provide referrals for formal diagnosis and treatment to those who screen positive. Methods: Postpartum depression screening using the EPDS was implemented in a pediatric emergency department over 15 weeks. The tool was administered to biological mothers of patients less than 12 months of age, who were not critically ill at presentation. The nurse collected and scored the tool, inputting the results into the electronic health record using a dot phrase. A positive screen was a score ≥ to 10 or a positive answer to the suicidal ideation question. If a positive screen was detected, a social work referral was completed. The social worker evaluated and provided mental health resources for the mother. Weekly chart audits were completed to track compliance and positivity rates. Results: 250 mothers were screened using the EPDS. Compliance with screening was 60%, with 97% of positive screens receiving a social work referral. 38 (17%) of the completed screens were positive. Of the positive screens, 6 (16%) mothers reported suicidal ideations. Conclusions: Screening for postpartum depression using the EPDS in the pediatric emergency department is feasible. It is also an opportune setting for identifying at-risk mothers and providing mental health resources due to the availability of social work and psychiatric emergency services.