Implementing a Universal Perinatal Depression Screening and Treatment Program in a Community Setting [21N]

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Abstract

INTRODUCTION:

Depression is one of the most common perinatal conditions, and fewer than half of cases are recognized. ACOG and USPSTF recommend that all pregnant women be screened during perinatal care. This is a quality improvement approach to implementing a universal perinatal depression screening and treatment program at Stamford Hospital, as well as a validity test of Patient Health Questionnaire-2 and -9 (PHQ2/9).

METHODS:

A didactic session on perinatal depression was held for OB/GYN and Family Medicine providers. In the following year, a retrospective chart review compared screening rates and management outcomes using the PHQ-2/9 and the Edinburgh Postnatal Depression Screen (EPDS).

RESULTS:

294 of 295 patients seen for a postpartum visit were screened using one or more tools. In this study, the PHQ2/9 had a sensitivity of 33% and specificity of 100%; those for the EPDS were 63% and 90%, respectively. Of the patients with a positive screen, 76% were referred to and seen by a Behavioral Health specialist. The overall prevalence of postpartum depression was 4%; 2 patients were prescribed antidepressant medications.

CONCLUSION:

This study established baseline postpartum depression screening rates, prevalence and treatment trends at Stamford Optimus Clinic. The condition is under-detected and poorly documented in this population; however, there was a high referral rate to behavioral health specialists after positive screens. The PHQ-2/9 was not as effective as the validated EPDS for depression screening. Future initiatives will utilize this data to create protocols to expand screening, standardize diagnoses, and improve management of perinatal depression.

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