Implementation of Universal Perinatal Depression Screening in Outpatient Obstetrics

Introduction/Purpose: This project implemented universal perinatal depression screening during pregnancy in an outpatient obstetrical setting in alignment with current recommendations from the American College of Obstetricians and Gynecologists (ACOG). Undiagnosed perinatal depression has been associated with poor birth outcomes and compromised maternal/newborn bonding, and may contribute to maternal mortality, as suicide is the second leading cause of death among prenatal and postpartum patients. Perinatal depression often goes unrecognized because women are reluctant to reveal their symptoms to their providers. Therefore, universal perinatal depression screening during pregnancy is recommended.

Methods: For this quality improvement (QI) project we conducted universal perinatal depression screening for pregnant patients in an outpatient obstetrical setting using two validated depression screening tools, the patient health qestionaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). We collected data to identify the number of patients referred for treatment after screening positive for perinatal depression after project implementation compared to the number of patients referred for treatment prior to project implementation.

Results: During project implementation 408 patients were eligible for screening, and 378 (98%) were screened per protocol (Figures 2 and 3). Before project implementation, an 8-week retrospective chart review revealed a total of six of 547 pregnant patients screened for perinatal depression based on depression symptoms (0.01%). Thus, screening for perinatal depression during pregnancy increased from 0.01% to 98% during the project implementation. During project implementation, 78 (21.0%) of the 378 participants screened positive for perinatal depression, and 72 (93.0%) (see Figures 4 and 5) were referred for psychiatric services. The retrospective chart review showed that during the 8 weeks prior to project implementation, six pregnant patients were screened for perinatal depression and all six screened positive. Of those six, three (50%) were referred for psychiatric services. Thus, during project implementation, the referral rate for pregnant patients screening positive for perinatal depression increased) from 50.0% to 93.0%.

Conclusions: This project established a foundation of perinatal depression screening in pregnancy to bring Regional One Health in alignment with the ACOG recommendations to screen pregnant women at least once during pregnancy as the first step in reducing the burden of perinatal depression in pregnancy. In our organization, this project accomplished the first step of establishing perinatal depression screening in pregnancy according to ACOG’s recommendation. We plan to expand this screening protocol into referral and treatment initiatives to provide our pregnant patients with optimal care.