Improving Maternal Mental Health: Implementation of a Standardized Postpartum Depression and Anxiety Screening Program

BACKGROUND: Perinatal mood and anxiety disorders (PMADs) are one of the most common complications of pregnancy and childbirth. There is inconsistent screening and identification of patients at risk of PMADs, resulting in patients rarely receiving appropriate mental health treatment. Untreated PMADs can lead to decreased mother-infant bonding and increased maternal suicide risk.

LOCAL PROBLEM: The setting for this project was a large, urban academic medical center in East Tennessee. There was no standardized process for PMAD screening and notifying providers after a positive screen. The project’s purpose was to implement a nurse-driven PMAD screening process to effectively screen and notify providers of patients with positive depression and/or anxiety screens before hospital discharge.

METHODS: This project was guided by the Evidence-Based Practice Improvement (EBPI) model. Plan-Do-Study-Act (PDSA) Cycles were used to test and improve practice change. Screening rates, nursing and provider documentation rates, positive depression and anxiety rates, and demographic data were measured over a 26-week implementation period.

INTERVENTIONS: Use of the Edinburgh Postnatal Depression Scale (EPDS) and a corresponding clinical decision-making algorithm were implemented to screen all postpartum patients on the postpartum unit.

RESULTS: There was a 91% screening adherence rate, with an 8% positive depression screening rate and a 19% positive anxiety screening rate. The co-occurrence for both positive depression and anxiety screens was 36%. Providers were notified of positive PMAD screens 66% of the time, and providers documented patient evaluation after a positive screen at a rate of 65%.

CONCLUSIONS: Screening all postpartum patients for PMADs prior to hospital discharge can lead to more timely access to mental health resources and treatment. This can help identify patients at risk for PMADs sooner than at the 2- or 6-week postpartum office visit. Continued collaboration and communication among providers and nursing staff at this facility is recommended to improve screening and provider notification rates.