Screening for Postpartum Depression at 0 to 12-Month Pediatric Visits

Almost 6% of new mothers will experience postpartum depression (PPD) during the 12-month postpartum period.

PPD is often undiagnosed, underdiagnosed, and untreated, increasing the risk for maternal mortality, which is highest in the second half of the postpartum period.

This quality improvement project started with educating a pediatric clinic team about a PPD Screening and Referral Pathway and then applying it to their practice when seeing new mothers and their infants during the first 12 months postpartum.

The PPD Pathway has instructions for the clinic team to give mothers the Edinburgh Postnatal Depression Scale (EPDS), complete the Receptionist Tracking Form, evaluate the EPDS, refer mothers who screen positive for PPD to behavioral health services, scan the EPDS into the mother's medical record, and complete the Referral Tracking Form.

The clinic team screened 112 mothers in 15 weeks from July to October 2024. Overall EPDS scores indicated possible distress (n = 112, m = 5.79±5.83). Over 15 weeks, 25% (n = 28) of mothers screened positive and received a referral to behavioral health services. The average infant age at the time of positive screen was 18 weeks (m = 4.2±3.49). Positive screens were steady during the first 9 months of the postpartum year with 22.4% at 0-3 months, 21.2% at 3.5-6 months, and 25% at 6.5-9 months. However, positive screens peaked with 80% at 9.5 to 12 months. Results from the Normalization Measure Development (NoMAD) questionnaire indicate that the clinic team wants to continue the PPD Pathway, which became a clinic quality measure.

Pediatric nurse practitioners and physicians can fill a gap in maternal care by screening for PPD, which can begin or intensify after the final postpartum obstetric visit. A standardized PPD Pathway is effective, feasible, and sustainable within the pediatric clinic setting.