Date of Award

Spring 5-25-2019

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Karen Macauley, PhD, DNP, MSN

Abstract

Abstract

Purpose: The purpose of this evidence-based project is to screen all mothers for postpartum depression at their infant’s 1-week, 1-month, 2-month, and 4-month well-child visits and to educate pediatric providers and mothers on the importance of early detection, referral and utilization of mental health services.

Background: Every year, 400,000 infants are born in the United States to mothers with depression, most of which have not been diagnosed or treated. The prevalence of postpartum depression (PPD) among immigrant and low-income women following birth, is estimated to be as high as 22%. Despite their high rate of prevalence, recognition and treatment of women with PPD is 14% lower than in the general population with depression. Children living with depressed mothers, often have limited responsive interactions and have been found to have altered stress response mechanisms, with potential cognitive, mental and behavioral developmental delays. The American Academy of Pediatrics has recommended the use of routine PPD screens at the well-child visits. Pediatric primary care clinics have a high rate of contact with mothers beyond their 6-week postpartum period and can potentially identify and refer at risk mothers and infants.

Evidence Based Interventions: Implementing PPD screening programs have led to higher utilization of mental health services for mothers identified with PPD. Incorporating a PPD screening category into the electronic health record (EHR) of the child will prompt staff and pediatric providers to routinely screen all mother at their 1-week, 1-month, 2-month, and 4-month well-child checks. The Edinburg Postpartum Depression Scale (EPDS) is the gold standard in PPD screening and has been validated for over 18 languages. For all positive screens, providers will assess need for an immediate mental health evaluation, discuss signs, risks, and treatment of PPD. Providers will then add to the child’s EHR, the diagnosis of Newborn affected by maternal depression, as it will prompt re-assessment for all future visits. Resource lists and educational materials will be provided to all screen-positive mothers, in their native languages.

Results: In the first six months of the project implementation, 273 women were screened at a total of 523 eligible office visits, (85.7% screening rate), 29(10.6%) mother screened positive and 24 (82.8%) women were referred to mental health services, 10 (41.7%) attended the referral. Fourteen (48.3%) of mothers with PPD had the appropriate EHR flag, in their infant’s record.

Conclusions: Early screening interventions can have significant impact in the prevention of complications for both the mother with PPD and the developing child. Engagement of pediatric providers is an effective modality to improve screening. This project is an example of the successful implementation of the American Academy of Pediatrics PPD screening guidelines and could be applicable to additional pediatric outpatient settings.

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