Increasing Postpartum Depression Screening and Intervention in a Pediatric Resident Clinic

Background: Postpartum depression (PPD) is a widespread problem, affecting an estimated 6-22% of mothers nationwide. Pediatricians, through frequent well child checks (WCCs), often have the most contact with postpartum mothers. Unfortunately, one in four mothers report no screening for PPD at these visits, and most cases likely go undiagnosed. As PPD negatively affects multiple arenas of childhood development and livelihood into adulthood, it is imperative that mothers receive screening and treatment resources. The Patient Health Questionnaire with a 2- and 9- question version (PHQ-2, PHQ-9) is an approved screening tool for depression, which is readily available to clinic providers. Given the frequency of which pediatricians have contact with these mothers in the neonatal period and the significant negative impacts PPD can have on a child, pediatricians can be a strong resource to detect and refer PPD in struggling mothers. Goal: Our objective was to increase rates of PPD screening, identification, and referral relative to our baseline. For all mothers, initial goals were to achieve a screening rate of 90% at newborn through first year WCCs, an identification rate of 10% (representing national average), and a referral rate of 100% of identified cases to appropriate resources. Methodology: We implemented a PPD screening process in our clinics using the Patient Health Questionairre-2 and Patient Health Questionnaire-9 (PHQ-2 and PHQ-9) and utilized chart review to measure outcomes. PDSA cycles thus far include: incorporating PHQ-2 screening into the EMR for WCCs ages newborn to one year, educating staff about the effect of PPD on the pediatric population and process for screening in clinic, incorporation of written PHQ-9 given at two-week, two-month, four-month, and six-month visits, and social worker placement within our clinic to provide resources to mothers screening positive. Future PDSA cycles to include: written PHQ-2 with follow up PHQ-9 as needed, adjustment of EMR to help ease of data entry, potentially screening fathers as well since paternal PPD incidence is an estimated 6% nationwide. Results: Preliminary results reviewing 495 visits show PPD screening rate increased from 71.7% to 84.4%. Identification rate based on screening tool increased from 2.1% to 5.5%. Documented referrals rate decreased from 81.2% to 60%. Discussion: Based on preliminary results, we have improved screening rates, with associated improvement in identification rates. We plan to provide further education on referral resources and documentation. The increased identification rate and continued referrals support the idea that pediatricians can be a valuable resource for mothers with PPD. We plan to continue tracking data to add to the study as we progress.