Prenatal screening for perinatal mood and anxiety disorders: a quality improvement project

Abstract

Perinatal mood and anxiety disorders (PMADs) are frequent complications during the perinatal period. If left unaddressed, they contribute to maternal morbidity and mortality and have negative impacts on the well-being of the infants and children. Screening at recommended time points increases the likelihood that individuals can access treatment and support. At a private Obstetrics and Gynecology (OB/GYN) clinic in western Montana, birthing individuals were not being routinely screened for PMADs at all recommended intervals, increasing the risk of undiagnosed PMADs and poor health outcomes. Using the Institute for Healthcare Improvement's (IHI) Model for Improvement, this quality improvement (QI) project aimed to implement a PMAD screening protocol at prenatal intake appointments. A short recorded educational presentation on PMADs was made available for all clinic staff to view prior to project implementation. The screening protocol involved screening with the Edinburgh Postnatal Depression Scale (EPDS) at prenatal intake appointments and brief, standardized follow-up for all screened patients to facilitate patient education and referrals for mental health care when needed. One clinic staff member confirmed viewing the educational presentation. A total of nine out of 54 (16%) eligible patients were screened. Of these, seven (78%) were confirmed to have received the standardized follow-up. This QI project minimally increased PMAD screening rates at prenatal intake appointments, indicating this is a feasible endeavor. Additional PDSA cycles, with increased stakeholder engagement and feedback, are recommended to further increase screening rates and standardized follow-up.