Standardized Postpartum Depression Screening and Treatment

Postpartum depression affects 7 to 20% of women in the first year after giving birth. Unfortunately, over 50% of women experiencing postpartum depression go untreated due to lack of detection, placing the woman and child at risk for detrimental consequences. One of the most common barriers in detecting and treating postpartum depression is the low incidence of screening performed at primary care and obstetrical visits during the postpartum period. Efforts have focused on improving identification of postpartum depression through the use of a valid screening tool performed throughout the first year. The purpose of the practice improvement project is to implement routine screening using the Patient Health Questionaire-2 (PHQ-2) at the four-to-six week and six month postpartum visits at a Community Clinic in a Midwestern City. The two question tool, assesses both sad mood and inability to experience pleasure from activities usually found enjoyable. If a patient answers yes to one or both of the questions, further clinical assessment should be performed to consider diagnosis. Once a patient is diagnosed, treatment through mental health counseling and/or medication should be ordered and consistent follow-up should be provided through phone calls and office visits. The practice improvement project was implemented in September, 2014 and evaluation took place three months post-implementation. Evaluation consisted of data collection, through chart audit and review, of all postpartum women, ages 18-49 years, who were seen by one of the three OB/GYN providers in the past year. The chart audits identified how many patients were seen overall, including demographic information. Chart audits also identified patients who were diagnosed with depression three months prior to implementation and three months post-implementation to determine a difference. Chart reviews further analyzed treatment and follow-up methods performed. Results of the project found an increase of postpartum depression detection from 8% to 15% and an increase in treatment methods. Inconsistency with follow-up methods were found and recommendations were made to address them. It was concluded that routine screening for postpartum depression, using the PHQ-2, provided a means to identify and treat postpartum depression in the primary care setting