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Posted: January 16th, 2024
Assessing Provider Knowledge and Practice Patterns Related to Screening for Postpartum Depression
Postpartum depression (PPD) is a common and serious mental health condition that affects up to one in seven perinatal individuals. PPD can have adverse effects on the well-being of the mother, the infant, and the family. Early identification and treatment of PPD can improve outcomes and reduce the risk of chronic depression, suicide, and impaired parenting.
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Screening for PPD is recommended by several professional organizations, including the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the US Preventive Services Task Force (USPSTF). However, screening rates remain low in many settings, and barriers to screening and referral persist.
This blog post aims to assess the current knowledge and practice patterns of health care providers who care for perinatal individuals regarding PPD screening. It also provides some suggestions for improving screening practices and overcoming challenges.
What are the current guidelines for PPD screening?
According to the ACOG Clinical Practice Guideline Number 4, "Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum", published in June 2023, screening for PPD should be performed at least once during pregnancy and once during the postpartum period using a validated instrument, such as the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire-9 (PHQ-9), or the Survey of Well-being of Young Children (SWYC). Screening should be accompanied by appropriate follow-up, referral, and treatment when indicated. The guideline also recommends screening for other mental health conditions, such as anxiety, bipolar disorder, postpartum psychosis, and suicidality .
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The AAP also endorses universal screening for PPD at the 1-, 2-, 4-, and 6-month well-child visits using a validated tool, such as the EPDS or the PHQ-9. The AAP provides a detailed roadmap for integrating PPD screening in pediatric practice, including identifying resources, obtaining parental consent, conducting screening, interpreting results, providing support and education, making referrals, and documenting care .
The USPSTF recommends screening for depression in adults aged 18 years or older, including pregnant and postpartum individuals. The USPSTF states that screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up .
What are the current knowledge and practice patterns of providers regarding PPD screening?
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Despite the clear recommendations from various professional bodies, PPD screening is not uniformly implemented in clinical practice. A systematic review of studies published between 2000 and 2018 found that PPD screening rates ranged from 9% to 100% across different settings and countries. The review identified several factors that influenced PPD screening practices, such as provider knowledge, attitudes, beliefs, skills, confidence, time constraints, availability of resources, reimbursement policies, organizational culture, and patient characteristics .
Some of the common barriers to PPD screening reported by providers include:
- Lack of familiarity with screening tools or guidelines
- Uncertainty about how to interpret or act on screening results
- Concerns about stigma or liability associated with PPD diagnosis
- Difficulty in accessing mental health services or referrals for patients
- Insufficient training or support on PPD management
- Low priority given to PPD screening compared to other clinical tasks
- Limited time or resources to conduct screening or follow-up
Some of the common facilitators of PPD screening reported by providers include:
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- Availability of validated and easy-to-use screening tools
- Clear and consistent guidelines or protocols for screening and referral
- Adequate reimbursement or incentives for screening
- Integration of screening into routine workflow or electronic health records
- Availability of on-site or online mental health services or referrals
- Provision of training or education on PPD recognition and management
- Supportive organizational culture or leadership
How can providers improve their PPD screening practices?
Based on the evidence from the literature and the experiences of successful programs, some suggestions for improving PPD screening practices include:
- Educating providers on the importance, benefits, and methods of PPD screening
- Providing providers with access to validated and user-friendly screening tools
- Developing clear and standardized guidelines or protocols for screening frequency, timing, administration, scoring, interpretation, documentation, follow-up, referral,
and treatment
- Ensuring adequate reimbursement or incentives for PPD screening
- Incorporating PPD screening into routine workflow or electronic health records
- Establishing collaborative relationships with mental health professionals or agencies
- Providing timely and appropriate referrals or consultations for patients with positive screens or high-risk factors
- Offering support and education to patients and families on PPD prevention,
recognition, treatment options, coping strategies, and resources
- Evaluating and monitoring the quality and outcomes of PPD screening practices
- Seeking feedback and input from providers, patients, and stakeholders on how to improve PPD screening practices
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Conclusion
PPD screening is a vital component of perinatal care that can improve the health and well-being of mothers, infants, and families. However, PPD screening is not widely or consistently implemented in clinical practice, and many barriers and challenges exist. Providers who care for perinatal individuals should be aware of the current guidelines and evidence for PPD screening, and adopt best practices to enhance their screening performance and quality. By doing so, they can help to reduce the burden of PPD and promote positive perinatal mental health outcomes.
Bibliography
: Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum | ACOG Clinical Guidance Clinical Practice Guideline
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: Integrating Postpartum Depression Screening in Your Practice in 4 Steps - AAP
: Final Recommendation Statement: Depression in Adults: Screening - US Preventive Services Task Force
: O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315(4):388-406. doi:10.1001/jama.2015.18948
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