A pilot implementation of postpartum depression screening guidelines in the pediatric primary care setting

Abstract

Statement of the problem. Postpartum depression (PPD) is a common postpartum complication. This condition can have a negative effect on family wellness and can impact the development of the infant. Unfortunately, it is estimated that only half of PPD cases are ever recognized and diagnosed by providers. Although evidence supports incorporating PPD screening guidelines into well-child visits, the pediatric providers at the project site do not routinely include this screening process in their practice. As a result, opportunities to identify mothers with PPD and provide them with education and resources were being missed. Methods. The project took place at an outpatient pediatric clinic in Montana. Four pediatric providers incorporated PPD screening guidelines utilizing the Edinburgh Postnatal Depression Screening tool into routine well-child checks for children ages 1 to 12 months. Using a data collection tool, providers recording data related to the screening process including the age of the child, whether or not the mother was screened, the EPDS score, and how the situation was addressed if the results of the EPDS were positive. The perspectives and beliefs of the providers were captured using a pre-implementation and post-implementation survey as well as a verbal debriefing at the end of the project. Results. Data were collected on 88 encounters where screening was indicated. Fifty-three of the 88 mothers were screened. Eight screenings were positive which suggested possible depression symptoms. Although providers were in favor of this practice change overall both before and after implementation of the PPD guidelines, some significant barriers and challenges emerged during the process. Discussion. Barriers to incorporating PPD screening guidelines into well-child visits include time constraints, cooperation and willingness of the mother to participate, remembering to administer the screening tool, and repetition of unnecessary screening in mothers who have already been diagnosed with depression. Changes could be made to the design of this project to reduce limitations and improve the implementation process. Overall, this project found that PPD screening at well-child visits has the potential to be feasible and valuable to the practice of this organization.