Standardized Postpartum Depression Screening in Pediatric Intensive Care Units

Abstract

Problem & Purpose: Postpartum Depression (PPD) affects 1 in 8 women and infants of mothers with PPD are at risk for long-term physical and mental-health problems. Mothers of critically ill children have an increased risk of PPD but may miss outpatient screening opportunities while their child is hospitalized. The Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU) in a Children’s Hospital do not have standardized screening for PPD. The purpose of this quality improvement project was to standardize PPD screening for mothers of infants less than 12 months using the validated Edinburgh Postnatal Depression Scale (EPDS). Methods: PPD Screening was conducted by nurses in the PICU and PCICU over a 14-week period. Nurses received education on screening including the use of a decision tree algorithm, an EPDS scoring key, quick tips, and a PPD resource support packet. All mothers of children 12 months and younger were eligible for screening. Nurses approached eligible mothers during admission and provided them with the resource packet and information on PPD screening and support resources. If mothers participated in screening, nurses then scored the completed EPDS tools and initiated a social work referral for borderline and positive scores. Results: 178 mothers were eligible, of which 25 (19.6%) were offered screening. Of those offered, 27 (77%) participated, 4 of whom had not been previously screened. EPDS scores ranged from 0-20 with an average score of 7.2 and 11 (40%) women had borderline or positive scores on the EPDS with one mother identified as having suicidal ideation. Screening compliance was low overall but was better in the PICU than the PCICU. Conclusions: The identification of women struggling with PPD that otherwise would not have been screened shows that screening for PPD in pediatric intensive care units is feasible and beneficial for promoting early support.