An Evaluation of Follow-up for Postpartum Depression in Mothers with a History of Depression

The purpose of this project was to evaluate provider follow-up at postpartum visits for women diagnosed with a history of depression before, during, or after a pregnancy in a large CNM/WHNP faculty practice. A chart review was completed on all women age 18 or older who gave birth at a large teaching hospital between January, 2013, and June, 2013. The project identified types and rates of postpartum depression follow-up utilized at 2 and 6 weeks postpartum in women diagnosed with a history of depression; evaluated the follow-up rates within the practice; and presented all findings to the faculty practice with suggestions to improve follow-up. Postpartum depression (PPD) is a serious mental health problem that affects between 9% and 16% of mothers. The greatest risk for PPD is in women with a previous history of depression before, during, or after a pregnancy. All major United States professional organizations providing care to postpartum women and infants recognize the risks of PPD and the potential benefit of screening, but the strength of recommendations is variable. Currently, none of the U.S. organizations recommend use of a specific tool, but give providers a list of available validated tools to choose from. Untreated PPD can have significant impacts on the mother, baby, and family. Women who are at risk for PPD should receive appropriate screening, evaluation, treatment, and/or referral for PPD. The postpartum period is an ideal time to identify and treat these women. By failing to diagnose more than half of depressed women, this is a missed opportunity. An initial chart review was completed on all women age 18 or older who gave birth in a large teaching hospital within the large CNM/WHNP faculty practice between January, 2013, and June, 2013, to identify women with a previous history of depression, depression during pregnancy, or postpartum depression. Thirty-nine women were identified with a diagnosis of history of depression before, during, or after pregnancy; 37 met criteria and 2 were excluded. The 37 cases were reviewed for evidence of follow-up, treatment, or referral of PPD during the 2 and 6 week postpartum visits. Demographics were also reviewed. The majority of women were white, insured, married, and had a history of depression before pregnancy. It was found that, at the 2-week visit 80.8% and at the 6-week visit 82.4% of women received follow-up with mental health questioning that cued open-ended responses. The Patient Health Questionnaire-9 was the only validated tool utilized by this faculty practice; at 2 weeks 11.5% and 6 weeks 17.6% of patients were screened with this validated tool. Of women not screened with a validated tool at 2 or 6 weeks postpartum, 10.8% developed PPD between 3 and 6 months postpartum. Only 7.7% of women received treatment with medication. Also referral for mental health services was not found to be common, offered to only about 13.5% of all women within this large CNM/WHNP faculty practice. The results of this project were presented at a faculty practice meeting with suggested improvement strategies