Improving Perinatal Mood and Anxiety Disorder Identification and Referral Process During Prenatal Care

Background: Perinatal Mood and Anxiety Disorders (PMAD), including depression, anxiety, and bipolar disorder, affect approximately 1 in 7 pregnant women and can have long-lasting effects on both mothers and children with ongoing complications. Initial prenatal screening facilitates early identification of PMADs ensuring appropriate evaluation and treatment.

Local Problem: The project team implemented a universal screening process during the initial 12-week prenatal appointment, aiming to screen 90% of women for depression and anxiety, and 60% for bipolar disorder. Additionally, the goal was for 60% of women with positive screens to receive further resources and/or mental health referrals.

Methods: Guided by the Evidence-based Practice Improvement Model, the project used the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression and anxiety, and the Mood Disorder Questionnaire (MDQ) for bipolar disorder. PDSA cycles were utilized to measure screening rates, positive screens, provider evaluation, resources, and project modifications.

Interventions: Patients with positive EPDS or MDQ screening results were evaluated by a provider and offered recommended resources, treatment, and/or referrals.

Results: Out of 367 patients, 304 were screened for depression and 293 for anxiety, for an average screening rate of 83%. Forty-two patients (14%) screened positive for depression and 62 (20%) for anxiety, with 32 (43%) exhibiting co-occurrence. Further, 305 patients (84%) were screened for bipolar disorder, with 7 (2.3%) screening positive. Providers documented screening and evaluated 60 (82%) of the 73 positive screens, with 38 (52%) receiving resources or referrals. All 7 positive bipolar patient screens had proper documentation and evaluation, with 4 (57%) receiving a resource or referral.

Conclusion: The EPDS and MDQ were administered at the 12-week prenatal visit over 83% of the time. More than half of those who screened positive were assessed by a provider and received appropriate resources, treatment, or referrals.