Maternal Postpartum Depression Screening in a Federally Qualified Health Care Center: An Evidence-Based Pilot Project
Background: Postpartum depression (PPD) affects 10% to 40% of women bearing children, increasing in low-income women and adolescent mothers. Postpartum psychosis affects 1 to 2 per 1000 pregnant women, further magnifying the need for regular PPD screening. The American Academy of Pediatrics recommends screening of mothers during the first to 6-month infant well checkups. Screenings have been recommended since 2004, but studies show a gap of only half of pediatrician groups performing PPD screening. The purpose of this study was to implement an evidence-based PPD screening guide in a federally qualified health care facility (FQHC) to assess feasibility/sustainability and address the gap in practice.
Sandy Jo James
Methods: A blinded descriptive quantitative analysis using an implementation research design was used for the 3-month pilot project. Working with focus groups, provider/staff training for the two provider teams who see children was completed, and parents were notified of the study when given the Edinburgh Postpartum Depression Scale. Compliance with screening and feasibility of the referral protocol were assessed.
Results: Mothers of patients aged 0 to 12 months in the study period were offered PPD screening 97% of the time. Providers and certified medical assistants agreed screening is important and generated a small increase in visit time. Screen scores identified one positive screen.
Conclusion: PPD demands screening during the first year of the mother/infant relationship. Pediatric providers have the ideal scheduling of well visits in which to incorporate PPD screening. A barrier for some pediatric practices may be time to follow up after referring a mother to mental health for evaluation of compliance with outside appointments. Having mental health services as a part of the FQHC team allows immediate evaluation/treatment resources when needed.