Establishing Routine Antenatal Depression Screening in a Medium-Sized Private Group Obstetric Practice

Background. Antenatal depression is one of the most common complications of pregnancy (UMMHC, 2016). Studies have found prevalence rates anywhere from 14-23% in obstetric populations. Unfortunately, less than ten percent of American adults are appropriately screened for depression, and this statistic likely translates to obstetric populations (APA, 2017). Proper identification and treatment of depression can greatly improve outcomes for the mother-baby dyad in the prenatal and postnatal period. Objective. The purpose of this project was to improve rates of depression screening among obstetric patients in a local OBGYN clinic. Methods. This project took place in a medium-sized private group obstetric practice. A multidisciplinary team was assembled to determine logistics and implement a universal depression screening process. Education was provided to the 15 obstetric providers (MD and CNM) on screening process, local counseling resources and evidence-based self-care non-pharmacologic practice recommendations that they can share with their symptomatic patients. Providers were surveyed pre and post intervention on estimates of patient screening rates, providers' level of confidence managing antenatal depression (AD), and logging resources providers used. Lastly, a retrospective chart review was done to determine actual levels of depression. Results. The pre-intervention questionnaire revealed that providers estimated screening 50% of patients, although 8 of the 15 providers said they never used a validated tool, and 7 reported that they "rarely" used one. Providers reported their pre-intervention level of comfort managing AD on a Likert scale of 0-10 at an average of 7.98. The mental health resources most commonly used included pharmacotherapy and counseling while three providers listed lifestyle changes and. The post-intervention questionnaire two months later showed an increase in estimated screening rates at 93%, all of these with a validated screening tool (the Edinburgh Postnatal Depression Scale, or EPDS). Average provider confidence increased to 9 on the Likert scale of 0-10. The Wilcoxon Signed-Rank test of differences in confidence levels was statistically significant (p = 0.05). The range of resources and education provided to patients broadened as 8 out of 15 providers reported using lifestyle changes and self-care practices, in addition to pharmacotherapy and counseling. A chart review showed that among patients seen for obstetric care in January and February of 2017, 21.6% showed evidence of AD. The same time period the following year (2018) revealed a depression rate at 21.1%. The difference was not statistically significant (P=0.91) and may be due to the limited amount of time universal screening had been in place prior to chart review. Conclusion. A universal standardized AD screening process was successfully implemented in an obstetric clinic. Provider confidence in recognizing and treating AD with pharmacologic and non-pharmacologic methods greatly improved. Clinic AD rates remain consistent based on chart review, however, should climb as more patients are screened throughout their pregnancy, leading to the improved quality of life for women suffering from depression.