Improving Recognition of Perinatal Depression Through Routine Prenatal and Postpartum Screening

Abstract

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement (QI)project was to support midwives and staff at a Phoenix area birth center in implementing standardized Edinburgh Postnatal Depression Scale (EPDS) screening in the prenatal and postpartum periods and referring patients to mental health resources when indicated. Background: Perinatal depression is depression that affects the pregnant individual during pregnancy and in the period following birth. Perinatal depression has significant short-term and long-term health consequences for the parent, infant, and family system. Perinatal depression can be fatal if left untreated. The Edinburgh Postnatal Depression Scale is a valid and reliable tool used to assist providers in the detection of perinatal depression. The midwives at the birth center had been discussing perinatal mental health at length with patients, though screening rates using a standardized tool in the prenatal and postpartum period remained at 9.5% and 14%, respectively. Methods: A 10-minute educational presentation followed by a discussion with midwives and staff was provided. The session provided education on risk factors, diagnosis, and treatment of perinatal depression, as well as documentation of EPDS screening in the Electronic Medical Record (EMR) and best practices for mental health screening and referral. Results: Following an educational presentation for clinical staff, including midwives, the project provided resources and encouraged collaborative efforts to ensure consistent screening. This DNP project successfully increased the perinatal depression screening rate at a Phoenix-area birth center through educational intervention with midwives and administrative staff. Prenatal and postpartum screening rates increased from 9.5% and 14% to 42.9% and 71.4%, respectively. Additionally, there was a 75% referral rate for EPDS scores of 9 or greater. Conclusions: Perinatal depression is a complication that continues to have significant mental and physical health effects. The educational intervention led to a statistically significant improvement in screening rates both prenatally and postpartum. There is a need for more research and process improvement efforts within this field to tailor perinatal depression screening and referral to the needs of different clinical settings.