Postpartum depression screening: are we doing a competent job?

[摘要] Postpartum depression (PPD) is one of the most commonand severe postpartum morbidity, affecting 10%–20%of mothers within the first year of childbirth. Theadverse effects of PPD, namely, prevention of motherbaby bonding and early cessation of breastfeeding,adversely affects infant growth and brain development.Studies have found that up to 50% of women withPPD go undiagnosed. Despite the American Academyof Pediatrics (AAP) recommendations, only a smallpercentage of paediatricians are currently screening forPPD. This project aimed to improve PPD screening usinga validated tool to 75% in a primary care inner-city clinicserving a predominantly underserved population as perAAP recommendations. Baseline data for 40 charts of2-month-old and 4-month-old well-child visits showed nodocumentation of PPD screening. The screening tool usedfor this project was the Edinburgh Postpartum DepressionScale (EPDS), which is a validated 10-item screeningquestionnaire for PPD. Three Plan-Do-Study-Act (PDSA)cycles were implemented involving educational strategies,system-based practice improvement and stakeholderparticipation. Improvement seen after PDSA cycle 1 wasminimal. At the end of cycle 2, 16/50 (33%) charts haddocumentation of screening using EPDS. At the end ofcycle 3, 33/40 (82%) charts had EPDS documentation,an increase of 49% from cycle 2. There were eight intotal positive PPD screenings between cycles 2 and3. These patients were provided counselling supportthrough a social worker and referral services throughthe local community mental health organisation. Weachieved more than our 75% target goal for PPD screeningimplementation at the residency clinic, thereby increasingresidents’ awareness of PPD and the importance of PPDscreening. Poststudy follow-up shows that screening wasmaintained at a higher rate but never reached 100%.

[学科分类] 药学