Postpartum Depression: The Secret Pain. A Unique Approach to the Crisis
- Identify 3 risks for developing PPD.
- Identify at least one environment in which PPD screening might occur.
- Suggest 3 treatment modalities for PPD.
With recent national attention to the devastating effects of postpartum depression (PPD) on women and their families, a Colorado HMO has put in place a multifaceted approach to prevention, early detection, and treatment. Prior to initiating this broad reaching plan, detection rates hovered around 2% in this health care system. With multi-specialty investment, the rate of identification has been increased to 14%.
Framework for the talk:
The program was designed using a task force whose members included specialists from pediatric and adult psychiatry, OB-GYN, pediatrics and advanced practice nurses (APN) specialized in the aforementioned fields. A comprehensive plan was developed, and all stakeholders were educated about all phases of the program. Ongoing evaluation of the effectiveness of the program is reviewed monthly by the task force.
Initial screening is done in the first trimester of pregnancy on patients at risk for depression and or anxiety, using the Edinburgh Postnatal Depression Scale (EPDS). This is done electronically and on paper prior to the visit. Positive findings allow providers to counsel patients early, initiate referrals to PPD prevention groups in the behavioral health system or begin medical treatment if indicated.
A second screening is done on the postpartum mother in the hospital prior to discharge by a Perinatal Advanced Practice Nurse while performing postpartum and newborn rounding. Any identified risk is referred to a team of APNs to do outreach calls 3-4 wks post delivery at the time when postpartum blues should be resolving and a statistical rise in PPD is seen. Patients who are positive at that time are either treated medically or referred to mental health for further evaluation and treatment.
The screening process continues when the pediatrician comes face to face with the mother at the infant’s 2 week check up where any concerns are referred to either the patient’s OB or mental health. Finally, when mothers are seen for their 6 week check up, the EPDS is repeated. Regardless of screening results, all women are educated about PPD, including the contributing factors, symptoms and treatments. This may help patients identify symptoms that occur after the screening period not only in themselves, but in their cohort, allowing this program to touch the lives of many beyond the boundaries of our patient population.
Implications for practice:
Through this team approach, using direct patient screening and an electronic record, nearly all of the 5000 women who deliver in the system annually are reached.
