Pi Phi Chapter

Detection, Treatment and Referral of Perinatal Depression Using Defined Algorithms for Care

Nursing Research on the Green

2014 Abstract

Ana Schaper PhD, RN; Xiaozan Anderson, Summer Nursing Research Fellow; Dawn Steffes, Research Associate Xiaozan Anderson, Summer Nursing Research Fellow; Gundersen Health System

  • Background:  Perinatal Depression (PND) encompasses major and minor depressive episodes that occur during pregnancy and/or the postpartum period. PND is one of the leading causes of disability and death during the pregnancy and postpartum period. PND is associated with poor maternal health, poor maternal attachment, depression in partners and negative effects on child development  .
  • Significance:  There is limited information in the literature on universal screening for PND across the perinatal period. Collaboration among the Obstetric, Pediatric and Family Practice Departments at a Midwest Medical Center resulted in the development of an algorithm for screening, referral and treatment of women scoring high on the Edinburgh Postnatal Depression Scale (EPDS). The EPDS is administered at the new obstetrical visit, the preview visit, after delivery and at 2 weeks, 6 weeks and 4 months postpartum.        
  • Purpose/objective:  To provide a comprehensive description of documented predictive risk factors associated with PND in the population base for this geographic area and document health outcome indicators of screening, referral and treatment algorithms.
  • Methods/project:  A retrospective chart review was conducted on 100 randomly selected women who scored high on the EPDS between 4/1/12 and 4/1/13. Data analysis include descriptive statistics and group comparisons using chi-square and t-tests.
  • Results:  Multiple predictive risk factors were present in women who scored high on the EPDS. The vast majority of women screened high on the EPDS for the first time at either the new OB or the Preview visits. Approximately half of the woman were formally treated with medication and/or counseling. Women with high depression symptoms were more likely to accept formal treatment. Rates of postpartum depression were very low with early identification in the pre-natal period. More than 80% of women had a low EPDS score at their last visit. However, return rates for the six weeks and 4 month postpartum visits were low.       
  • Clinical implications:  The electronic medical record needs to be refined to provide a comprehensive picture of women’s past medical history, risk factors and strengths. Stressors in women’s lives need to addressed at the new obstetrical visit while also building social supports and wellness practices. New onset PND should be differentiated from ongoing depression at the new obstetrical visit to provide for best practices in caring for women with depression. The algorithms need to be enhanced to provide women with ongoing support with their primary care providers.

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