Improving inpatient postpartum depression screening: results from a quality improvement initiative

Screening is necessary to identify patients with postpartum depression or anxiety and facilitate access to mental healthcare. This study evaluated a quality improvement initiative for inpatient postpartum depression screening, which was implemented to better identify patients in need of mental healthcare. This initiative replaced the Patient Health Questionnaire (PHQ-9) administered verbally by nurses with the Edinburgh Postnatal Depression Scale (EPDS-10) self-administered by patients via iPads.

Electronic medical records for patients who delivered June 2020-October 2023 at Cedars-Sinai were analyzed (N = 17,403). Differences in completed screenings, positive depression screenings, suicidal ideation, and social work referrals before and after the initiative were examined with chi-square tests and multiple logistic regression models. Factors associated with positive anxiety screenings on the EPDS-10 were also identified.

Overall, 98.6% of patients completed depression screenings. Among those who completed screenings, positive depression screenings increased from 4.0 to 11.4%, identified suicidal ideation increased from 0.2 to 1.1%, and social work referrals increased from 64.1 to 84.0%, before and after the initiative. Post-initiative, patients had higher odds of positive depression screenings, indicating suicidal ideation, and receiving social work referrals compared to pre-initiative. Among those who completed EPDS-10 screenings, 31% were positive for anxiety.

Compared to the PHQ-9 administered verbally by nurses, the EPDS-10 self-administered by patients via iPads resulted in higher rates of positive depression screenings, identified suicidal ideation, and social work referrals. It is imperative to accurately screen patients for postpartum depression and anxiety to facilitate access to mental healthcare and address morbidity and mortality.

Not applicable.