Background: Postpartum Depression can have a negative impact on the physical, cognitive, and behavioral development of children. In the most extreme cases, it can be associated with the cause of death for mothers and their children. Some risk factors that can lead to Postpartum Depression are teenage pregnancy, late or lack of prenatal care, food/housing insecurity, and low income. According to recent studies, only 11% of mothers with Postpartum Depression reported receiving a Depression diagnosis from a healthcare provider. Postpartum Depression is screened for at our medical center’s Pediatric Clinic with the Patient Health Questionnaire (PHQ-9) at 2, 4, and 6 month well child visits. Between April 2023 and August 2023, only 60.8% (284/467) of eligible mothers at our medical center’s Pediatric Clinic were screened for Postpartum Depression. The goal of this intervention is to increase the amount of Postpartum Depression screenings conducted in the Pediatric Clinic by 10%.
Methods: Postpartum Depression screenings are completed on paper by the mother and entered into their child’s electronic medical record (EMR) during the well child visit. Pilot data was gathered through chart review of all well child visits for children ages 2 months, 4 months and 6 months between April 2023 and August 2023. A completed Postpartum Depression Screening was considered to be one of the following: a patient note with PHQ-9 or PHQ-A Screening entered electronically with answers to each of the 9 questions provided, a patient note with only PHQ-9 Screening results recorded in the patient’s assessment and plan without individual answers recorded, a patient note with the ICD-10 Code for “Encounter for Postpartum Depression Screening” [Z13.32] entered in the patient’s Problem List with the PHQ-9 result included. Once data was collected, an in-service was conducted with all staff in the Pediatric Clinic (including Residents, Attendings, and Nurse Practitioners) to emphasize the importance of the Postpartum Depression Screenings and the impact that Postpartum Depression has on our patient population. All providers were also provided access to a database with PHQ-9 Screening tests available in 30 different languages. Post-intervention results were then collected in a similar fashion for the next two months following the in-service.
Results: After the intervention, Postpartum Depression Screenings increased from 60.3% (108/179) to 89.6% (43/48), from 66.7% (100/150) to 75.6% (34/45), and from 55.1% (76/138) to 85.7% (24/28) for the 2, 4, and 6, month well child visits, respectively. The overall percentage of completed Postpartum Depression Screenings was 83.5%, a 22.7% increase from the original 60.8% prior to the intervention.
Conclusions: Emphasizing the importance of screening and providing access to the PHQ-9 in multiple languages played an integral role in increasing the amount of screenings that were able to be completed. Mothers who indicated positive results on the PHQ-9 (a score of 10 or above) were then referred to our in-house social worker who is then able to connect the affected mothers to resources to provide aid for food insecurity, mental health issues, and housing insecurity. In order to force function and hold the current gain, the EMR provider for the Pediatric Clinic has been contacted with a goal of preventing providers from being able to close out patient charts without completing the PHQ-9 screening for eligible mothers.
