Application of Evidence Based Practice: Screening for Postpartum Depression in the Hospital Setting

Application of Evidence Based Practice: Screening for Postpartum Depression in the Hospital Setting

Not all women experience the highs of being a new mother - ten to twenty percent of all women experience only the lows (Horowitz & Goodman, 2005). Postpartum depression (PPD) is a mood disorder that occurs within the first postpartum year (Beck 2006), which can pose a significant risk to new mothers, their infants, and their families.  The greatest risk of PPD is the fact that it has negative effects on the developing relationship between the new mother and her infant, and also, can be a detriment to the cognitive social and emotional development of the infant. If PPD is left undiscovered and untreated, chronic depression can develop.            A number of screening tools have been developed since PPD has been recognized as a mental disorder, but at this time, antepartum and postnatal screening for postpartum depression “is not standard clinical practice in the US” (Horowitz & Goodman, 2005).  The AWHONN position paper (2002, pp.1) stated that, “Health care providers … should integrate routine screening protocols … related to PPD into their standard practices of care for prenatal and postpartum women.”            Identifying women who may be at risk for PPD is important clinically.    According to Austin and Lumley, (2003), use of assessment measures and clinical interviewing may detect known prenatal risk factors and depressive symptoms, thereby giving clinicians a basis to suspect the development of PPD.  Horowitz and Goodman (2005) assert that early identification of depressive symptoms and risk factors are needed in order for at-risk women to be identified and treated early.             In this particular Northern Virginia hospital a screening pilot was initiated as an educational model with an innovative midwife and obstetrical group. There was a collaborative meeting between the directors of the labor and delivery unit, postpartum obstetrical unit, the chief of obstetrics to exchange ideas and develop a plan for implementation of screening with the Edinburgh Postpartum Depression Screening instrument during day 2 to 3 following delivery.

After one month of screening in the hospital setting, the number of patients with detected risk factors for postpartum depression for this practice was 2 patients out of 20 consenting patients, or 10% of the patients evaluated.  The rate of detected PPD for this practice in the previous month when in-hospital screening was not done was zero.            The review of this pilot data finds that screening for PPD in the hospital setting can be an effective tool to identify mothers at risk for PPD or who are depressed. Screening for PPD prior to discharge gives the new mother an opportunity to utilize many resources (including obstetricians, midwife, nurse, social worker, case manager, and psychiatric liaison nurse) for support in the hospital setting and may not be as readily available in the community upon discharge. Best practice models support screening for PPD using the Edinburg Postpartum Depression Scale instrument in the hospital setting following delivery.