Depression Screening During

Pregnancy and the Postpartum

Period
Justin Burgett, Tessa Eckhardt, and Alyssa Matulich
 Gap In Practice
● Perinatal depression impacts one in seven
women
○ Depression during both pregnancy and the postpartum
period
● One of the most underdiagnosed obstetric
complication in the nation
○ Symptoms attributed to normal hormonal fluctuations
of pregnancy
● Failure to screen for depression in offices in
both the Chattanooga and North Georgia
community
○ No current policy to guide screening and management
National Guidelines

● USPSTF- annual screening for depression in all adults aged 18 and older, including
pregnant and postpartum women, as a category B recommendation
● ACOG- women be screened for depression and anxiety symptoms at least once during
the perinatal period, a time frame that ranges from the beginning of pregnancy through
the first twelve months postpartum
● AAP- supports screening with the EPDS at regular newborn well-visits at 1, 2, 4, and 6
months
● AAFP-screening of all individuals using the two question Patient Health Questionnaire
(PHQ-2) and pregnant patients with the PHQ-2, PHQ-9, or EPDS at least once during the
prenatal period
 Action Plan
● Using national guidelines and Massachusetts Child Psychiatry Access
Program for Moms (MCPAP for Moms) provider toolkit to guide our quality
improvement project
○ Key concepts regarding assessment of maternal mood and depression
○ Definitions and descriptions of emotional complications that may be experienced in pregnancy and the
postpartum period from Baby Blues to postpartum psychosis
○ Advice on how to screen and interpret results of the EPDS
○ Algorithms that guide action based on EPDS scores and what type of treatment, if necessary, should be
considered

https://www.mcpapformoms.org/Docs/Adult%20Toolkit_10.10.17.pdf
Implementation
● Educational Sessions
○ 2 Lunch and Learn sessions lasting 2 hours each
● Timing of Screenings
○ Initial, 27-28 weeks, and six weeks postpartum
○ 2 weeks postpartum with pt history
● EPDS to be completed by pt
○ In office or online prior to visit
● Medical Assistant responsibility
● Algorithm by MCPAPs
● Provider responsibility
○ Treatment, referral, education
● Use of EHR
○ Soft stop
 Evaluation
Three step process:

● Six month chart review before and after intervention

implementation
○ Use of ICD-10 and CPT codes for screening
○ Use of ICD-10 codes in F01-F99 code block
● Survey of staff for ease of use
○ Likert Scale and short answer
● Patient Outcome Evaluation
○ Repeat screenings after treatment and intervention
Communication
● Providers and office managers
○ Keep abreast of process
○ Update with evaluation findings
● Frontline staff and MAs
○ Ensure compliance with study
○ Update as needed if process
improvements are identified
● Collaborate with specialists if treatment
outside of provider’s comfort
Sustainability

● State mandated screening

○ New Jersey, Illinois and West Virginia
○ 12 states have state sponsored education or awareness
program
○ No impact on Medicaid pts
● The MOTHERS Act
○ Funds yet to be disbursed
● MCPAP for Moms
○ Increased surveillance and treatment of perinatal mental
health disorders
Project Summary

● Patient Impact
○ Parenting practices, child
development, family stability
○ Breastfeeding, infant sleep,
adherence to well child visits and
vaccine schedules
● Patient Safety, Ethics, and Cultural
Needs
● Project Limitations
○ Staff resistance
 References
American College of Obstetricians and Gynecologists (ACOG). (2018). Screening for perinatal depression (ACOG Committee Opinion No. 757). Obstetrics and Gynecology, 132(5), e208-e212.

Byatt, N., Biebel, K., Hosein, S., Lundquist, R., Freeman, M., & Cohen, L. (2017). MCPAP for moms: Promoting maternal mental health during and after pregnancy. Retrieved from
https://www.mcpapformoms.org/Docs/Adult%20Toolkit_10.10.17.pdf.

Byatt, N., Straus, J., Stopa, A., Biebel, K., Mittal, L., & Moore Simas, T.A. (2018). Massachusetts child psychiatry access program for moms: Utilization and quality assessment. Obstetrics & Gynecology, 132(2),
345-352. doi: 10.1097/AOG.0000000000002688.

Curry, S.J. (2019). Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement. JAMA, 321(6), 580-587. doi: 10.1001/jama.2019.0007.

Earls, M.F. (2010). Clinical report: Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics, 126(5), 1032-1039. doi: 10.1542/peds.2010-2348.

Massachusetts Child Psychiatry Access Program (MCPAP). (2014). MCPAP for Moms. Retrieved from https://www.mcpapformoms.org/Default.aspx.

Maurer, D.M., Raymond, T.J., & Davis, B.N. (2018). Depression: Screening and diagnosis. American Family Physician, 98(8), 508-515.

Netsi E., Pearson R.M., Murray L., Cooper P., Craske M.G., & Stein A. (2018). Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiatry, 75(3), 247-253. doi:
10.1001/jamapsychiatry.2017.4363.

Rhodes, A. & Segre, L. (2013). Perinatal depression: A review of U.S. legislation and law. Archives of Women’s Mental Health, 16(4), 259-270. doi: 10.1007/s00737-013-0359-6.

Sui, A.L. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA, 315(4), 380-387. doi: 10.1001/jama/2015.18392.

Weissman, M.M. (2018). Postpartum depression and its long-term impact on children: Many new questions. JAMA Psychiatry, 75(3), 227-228. doi: 10.1001/jamapsychiatry.2017.4265.