Implementation of a Universal Screening Program to Increase Identification and Treatment of Perinatal Mood and Anxiety Disorders Among Pregnant and Postpartum Women

Abstract

<p>&lt;p&gt;Purpose: The purpose of this project is to evaluate whether the consistent implementation of a valid and reliable screening tool for perinatal mood and anxiety disorders in the clinic setting, as well as follow-up care, will result in better identification and treatment. &lt;/p&gt;</p> <p>&lt;p&gt;Summary: From January-May 2017, clinicians at the OB/GYN clinic implemented use of the Edinburgh Postnatal Depression Scale (EPDS) to screen patients for perinatal mood and anxiety disorders at the initial obstetric visit, 24 week visit, 36 week visit, 2 week postpartum visit (if applicable), and 6 week postpartum visit. With EPDS scores of &ge;10, the clinician performed risk assessment and referred patient to a local perinatal mental health clinic when indicated. To assess for overall effectiveness of the project, chart reviews of all eligible participants were performed. Data was extracted from the electronic health record (EHR) including EPDS scores and ICD-10 codes to determine the number of women with symptoms of perinatal mood and anxiety disorders identified by the clinician. &lt;/p&gt;</p> <p>&lt;p&gt;Outcomes: Of 836 total participants who met eligibility criteria, 619 women were included in the QI project. A 494% increase in identification of women with perinatal mood and anxiety disorders was seen with implementation of the screening protocol. Over 87.4% of women with EPDS scores &ge;10 were given education about perinatal mood and anxiety disorders, offered behavioral referrals, and local resources. Over 65% of participants with perinatal mood and anxiety disorders were provided with referrals to behavioral health; 42% of them completed an appointment with a behavioral health specialist to address symptoms. &lt;/p&gt;</p> <p>&lt;p&gt;Implications: Standardized, universal screening for perinatal mood and anxiety disorders improves the detection rate. Screening for perinatal mood and anxiety disorders during pregnancy, especially at the initial prenatal visit, can result in earlier identification. Earlier identification of women with perinatal mood and anxiety disorders can result in more prompt intervention and management of symptoms. Screening with use of the EPDS in the OB/GYN clinic is cost effective, efficacious, and easily reproducible. While screening is important, ensuring adequate behavioral health follow-up is crucial in the management of women with perinatal mood and anxiety disorders. &lt;/p&gt;</p>