The Use of Ecomaps to Identify Social Determinants of Mothers With Postpartum Depression in the ETSU Pediatric Clinic

The birth of a child can be a stressful time accompanied by an array of emotions including depression. Postpartum depression (PPD) affects approximately 1 out of 7 new mothers. It can affect a new mother’s sleep, appetite, mood, and bond with her baby, as well as impact child development and well-being, if left untreated. Beginning in March, 2013, ETSU Pediatrics deployed an evidence based screening tool, the Edinburgh Postpartum Depression Scale (EPDS), to identify mothers of newborns with PPD. Mothers attending well-visits with their baby from birth to six months of age who score above an eight on the screener are provided with education about PPD, referrals, brief on-site counseling, and phone-call follow- up. Many of these mothers express concerns about resources and social factors that impact their health and mood. An Ecomap is a visual representation of strengths and stressors of a patient’s relationship with their environment, social supports, and resources. The awareness of a patient’s relationships and support within their environment can be useful for assessment of needs and intervention on their behalf. The objective of this study is to pilot the utility of the Ecomap to illuminate common stressors of the social determinants contributing to or exacerbating symptoms of PPD, in order to provide brief solution-focused interventions and referrals to alleviate the stressors. Although Ecomaps have been utilized in clinic settings, there is a lack of research on their effectiveness in identifying social determinants of mothers with PPD. We hypothesized that implementing the Ecomap with mothers that present with an elevated EPDS score will identify a significant number of social determinates that are actionable by social workers on staff. When a mother presented with a score of eight or above on the EPDS administered during a well-child check, the social work staff completed an Ecomap with mothers via a warm handoff. The social determinants identified on the Ecomaps were then categorized and counted to determine biggest social needs of mothers at the ETSU Pediatric clinic from 11/13/2015 through 02/28/2016. The clinic completed 27 ecomaps with mothers who scored 7 or above at well child checks. Transportation and mental health services presented as the most common domains that social work was able to effectively act to rectify. Overall, the utilization of the Ecomap was successful in identifying social determinants contributing to or exacerbating symptoms of PPD. Addressing these stressors through resource allocation and brief solution-focused therapies may contribute to a reduction of PPD symptoms. Future research, therefore, should examine whether addressing these social stressors reduces symptoms of PPD above and beyond targeting depressive symptoms alone in mothers presenting at pediatric clinics