A Project to Implement Routine Perinatal Depression Screening at the St. George OB/GYN Clinic

Background: Perinatal depression (PD) is a complication of pregnancy and postpartum. Unfortunately, many obstetric and primary care providers do not screen for perinatal depression leading to its underdiagnosis. Untreated PD has severe consequences for the pregnancy dyad and family, ranging from preterm delivery to suicide. Universal screening using a validated tool effectively detects perinatal depression. Proper identification and treatment of perinatal depression can significantly improve maternal and infant outcomes. Methods: This project aimed to initiate PD screening among obstetrical patients using a validated tool. This quality improvement project occurred in a small private practice obstetrical and gynecological (OB/GYN) clinic in southern Utah. A single educational in-service was presented to the providers and ancillary staff, including Doctor of Medicine, Certified Nurse-Midwives, Family Nurse Practitioners, and Medical Assistants. Education included PD prevalence rates, PD consequences, American College of Obstetricians and Gynecologists (ACOG) and the United States Preventative Services Task Force's screening recommendations, a practice-specific PD screening process using the EPDS tool, local PD resources, and evidence-based pharmacological recommendations for PD treatment. Measurement included pre- and post-education questionnaire results and the results gathered from pre- and post-project estimation rates of PD screening. Results: Before initiating the project, universal PD screening using a validated screening tool did not occur. Post-intervention, providers estimated that mostly all perinatal patients were screened for PD. The pre-intervention comfort level of providers screening for PD varied from somewhat uncomfortable to very comfortable. In contrast, all providers rated their post-intervention comfort level of screening for PD as "very comfortable." Conclusions: A standardized practice-specific PD screening process using a validated screening tool was successfully initiated in the St. George OB/GYN clinic. Providing PD education, including using a validated screening tool, to providers and staff was associated with an improved comfort level among providers regarding PD screening and treatment. The hope is that standardized universal screening and treatment of PD will improve maternal and fetal outcomes and enhance the quality of life for women suffering from depression during the perinatal period.