Screening for Postpartum Depression in the Newborn Intensive Care Unit (NICU)

Background: Postpartum depression (PPD) is one of the most common obstetric complications that women will experience, with a prevalence of 12.5% in the United States. Women with infants admitted to the Newborn Intensive Care Unit (NICU) are at an even more significant risk for developing PPD, with a prevalence of approximately 40% in this specific population. PPD is routinely screened for by pediatricians at well child visits. However, many NICU infants will require long-term hospitalization and therefore will not attend a well-child visit during one or more of the PPD screening visits recommended by the American Academy of Pediatrics (AAP). This means that mothers of infants in the NICU are likely to be screened less frequently than other women during their postpartum period. Local Problem: Screening for postpartum depression in the NICU setting has not historically been conducted at the University of Utah hospital, despite these mothers being at increased risk and likely less screened than those without infants admitted to the NICU. Methods: A quality improvement project was developed to increase PPD screening for NICU mothers within the NICU setting. First, a needs assessment was conducted to review any screening protocol or resources already in use. In the second phase, a PPD screening tool was created for the nursing staff to administer to parents. A protocol for how to screen parents and an algorithm for determining referral needs was created. If referral to social work was indicated, an order was placed and follow-up from social work was expected within 3 business days to provide PPD resources and to assess the mother's coping. At project conclusion, data were analyzed to provide information on the incidence of PPD among NICU mothers. Finally, a post-intervention survey was sent to the bedside nurses who participated in the project to assess for satisfaction and sustainability of the PPD screening protocol. Intervention: Bedside postpartum depression screening of mothers while they visit their infants in the NICU was implemented to improve screening rates for this specific population of postpartum mothers. Results: Twenty NICU mothers were screened for PPD while they visited their infant at their bedside. Prevalence of PPD in participants was found to be 15 percent (n=3). Six bedside nurses completed the postintervention survey, and all reported that they were satisfied with the new screening process and referral protocol. No participant mothers required emergency psychiatric referral. Conclusions: This project was valuable in identifying mothers at increased risk for PPD in the NICU setting. All mothers who screened positive were promptly connected with the in-house social worker. This afforded those mothers rapid access to resources and additional support during this difficult time.