Standardizing screening methods for postpartum depression in a rural community clinic: a quality improvement project

Abstract

Postpartum depression is a significant public health concern affecting approximately 15.2% of Montana mothers. Early screening and detection are crucial for effective management and improving long-term outcomes for mothers and infants. This quality improvement project was aimed to establish evidence-based screening practices to screen for postpartum depression in a rural Montana clinic. The Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionere-9 (PHQ-9), and the Center for Epidemiologic Studies Depression Scale (CESD-10) were compared and the EPDS was subsequently chosen. Screening frequency was evaluated, and the evidence supported screening at the initial obstetric visit, once between 24-28 weeks, and 6 weeks postpartum. Additionally, screening is recommended as mothers intersect with the healthcare system during well child visits for the first year of life. Data were collected over three PDSA cycles, each lasting two weeks. Key outcome measures included eligible patients screened, actual patients screened, and positive screens. Additionally, the project assessed whether follow up was completed on positive screens. A total of 28 patients were eligible and 20 completed the EPDS. Of the 26 screened patients, 4 were positive and 4 had appropriate follow up. The quality improvement project demonstrated the feasibility and effectiveness of standardized PPD screening. By identifying at risk individuals early and providing intervention, this project contributed to improving outcomes and promoting comprehensive family centered care. Further evaluation and refinement with a larger sample is recommended to optimize the sustainability and impact on clinical practice.