Implementation of the Edinburgh Postnatal Depression Scale as a Universal Screening Tool in a Rural Utah Postpartum Population

Background: Major and minor depressive episodes during the perinatal period impact 12-20% of all childbearing women. Consequences of maternal depression include maternal dysfunction- psychosocial, relational, occupational, and physical, pre-term delivery, dysfunction in the maternal-infant relationship, impaired infant attachment, childhood behavioral problems, and in severe cases, can be directly related to maternal suicide and infanticide. In addition, maternal postpartum depression (PPD) is considered an adverse childhood experience (ACE) and can contribute to other compounding ACEs such as family dysfunction, abuse, and neglect. These can lead to long-term health implications for both the mother and her child. Methods: Pre and post-project interviews were developed to ascertain healthcare providers' knowledge about PPD and their baseline comfort level with initiating PPD screenings at a women's health clinic in rural Utah. An educational presentation, protocol, and resource packet were designed and distributed to the clinic's obstetric provider and medical support staff. The presentation included information about PPD, the Edinburgh Postnatal Depression Scale (EPDS) screening tool, and treatment options for women with positive EPDS scores. A post-intervention interview was conducted to evaluate changes in clinic providers' knowledge of PPD, comfort level discussing PPD with patients, the number of completed EPDS screenings, and the number of patient referrals for women with positive EPDS scores. Results: The rural provider found the EPDS screening tool valuable in detecting postpartum depression and invited opportunities for conversation with patients about the signs, symptoms, and risks of postpartum depression. The participant reported that the screening rate was 0.06% (n=1) of his postpartum patients for four weeks prior to the intervention. However, the number screened improved once staff overcame the discovered barriers, and during the second implementation period in the last two weeks, screening rates were 70 % (n=7) of his postpartum patients. Conclusions: The EPDS screening tool appears to be a valuable resource to help increase the detection and treatment of postpartum depression in a rural women's clinic. However, addressing workflow barriers will help maintain the consistency of this intervention in this clinic. Replication of this quality improvement project is needed to determine if other rural women's health clinics would produce similar results.