Recognizing Maternal Mental Health: An Initiative to Improve Perinatal Depression and Anxiety Identification during Prenatal Visits Using a Standardized Screening Protocol

Background: Perinatal depression (PD) is a common pregnancy complication. There are several predictive risk factors for PD, including co-occurring anxiety. Mental health conditions are the leading cause of preventable perinatal deaths. Screening for depression and anxiety during prenatal visits is recommended for early identification, evaluation, treatment, and follow-up.

Local Problem: An obstetrics/gynecology clinic in East Tennessee lacked a process for screening depression and anxiety during prenatal visits. The project team established a process to screen for depression and anxiety at the 28-week prenatal visit. The aim was to screen 40% of women at the 28-week prenatal visit, with 60% of those who screened positive receiving evaluation by the provider and recommended behavioral health resources based on symptom severity.

Methods: The project was guided by the Johns Hopkins Evidence-Based Practice Model. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depression and anxiety. The counts of women who completed a screening, screened positive, and received recommended resources and referrals were measured through four PDSA cycles.

Interventions: An EPDS cut-off score of greater than or equal to 10 or a > 0 response to question 10 indicated a positive depression screen. While a score of greater than or equal to 5 from three anxiety-related questions from the EPDS indicated a positive anxiety screen. Women who screened positive were evaluated by a provider and received recommended resources and referrals.

Results: Out of 366 patients, 293 (80%) were screened at their 28-week prenatal visit. Utilizing the EPDS, 14% of patients screened positive for depression and 26% for anxiety. Forty-six out of 83 patients who had a positive depression and/or anxiety screen received behavioral health resources or treatment.

Conclusion: The EPDS was administered to patients at their 28-week prenatal visit over 80% of the time. Over half of those patients with a positive screen were further assessed by a provider to determine recommended resources, treatment, or referrals.