Outcomes of Implementing Routine Screening and Referrals for Perinatal Mood Disorders in an Integrated Multi-site...

Area of Science:

• Perinatal Health
• Mental Health Services
• Quality Improvement

Background:

• Postpartum depression (PPD) affects a significant number of women, impacting maternal and infant well-being.
• Access to timely mental health services is crucial for effective PPD management.
• Integrated care models in obstetric and pediatric settings offer opportunities to improve PPD screening and referral.

Purpose of the Study:

• To implement and evaluate a quality improvement project aimed at increasing access to perinatal mental health services.
• To establish universal screening for postpartum depression (PPD) within a multi-site integrated healthcare system.
• To facilitate referrals for evaluation and treatment for women screening positive for PPD.

Main Methods:

• Universal screening for PPD using the Edinburgh Postnatal Depression Scale (EPDS) was conducted twice during pregnancy and at 6 weeks postpartum.
• Pediatric practices screened women at 2-week and 2, 4, and 6-month well-baby visits.
• Women scoring 10 or higher on the EPDS or reporting self-harm thoughts were referred to mental health providers, with data tracked via electronic medical records.

Main Results:

• Over 102,000 PPD screens were completed, with 6.3% screening positive.
• 3.8% of women were referred for treatment, and 55.8% completed a mental health appointment within 60 days.
• Referral completion rates varied significantly based on the level of integration, from 20.0% in coordinated systems to 82.7% in integrated models.

Conclusions:

• Integrating PPD screening into obstetric and pediatric practices is feasible and effective.
• Successful implementation requires thorough planning, systems review, and trained staff.
• Higher levels of integration between mental health providers and referring physicians correlate with improved treatment completion rates.