Implementation of EPDS and Perinatal Mental Health Resources in Spanish for an Urban OB Clinic Serving Spanish-speaking Immigrants

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth and impact one in seven women. The Edinburgh Postpartum Depression Scale (EPDS) is the gold standard for PMAD screening. Black and Latina women have higher rates of PMADs and have barriers to accessing mental health services. Screening can identify individuals experiencing symptoms of PMADs and direct them to professionals for further evaluation and treatment if needed. Local Problem: An urban OB clinic experienced a significant increase in Spanish-speaking patients. The clinic has not been screening these patients in Spanish for PMADs and is also unaware of places to refer patients to Spanish-speaking therapists or psychiatric medication providers. Methods: This quality improvement project included screening for PMADs using the Spanish version of the EPDS at a local OB clinic. A pre-implementation survey evaluated the current use of the EPDS in Spanish and assessed provider and staff comfort in administering and scoring the EPDS. Clinic staff received training about PMADs, the importance of screening patients, and how to make proper referrals. In addition, the clinic received an education handout in Spanish and a resource pamphlet of Spanish-speaking mental health professionals to distribute to Spanish-speaking patients. A post-implementation survey assessed the project's usability, feasibility, and provider satisfaction of the project. The medical executive director of the clinic received an executive summary with feedback and future recommendations. Interventions: The clinic received an educational handout and resources pamphlet of Spanish- speaking mental health professionals to distribute to patients. Clinic staff collected completed Spanish EPDS forms during the measurement period. Results: Post-implementation, 76% (n=13) of participants felt confident administering and scoring the EPDS in Spanish. In addition, 82% (n=14) of participants felt confident making a mental health care referral for a Spanish-speaking patient, and 100% (n=17) reported they would continue to use the referrals in their practice. There was an 11.6% rate of positive EPDS Spanish forms, with 43 forms collected. Conclusion: This project improved PMAD screening rates in a Spanish-speaking population using the Spanish version of the EPDS and created a patient education handout and a referral list of Spanish-speaking therapists that providers could give to their patients. The clinic staff and providers found the addition of the EPDS and other resources in Spanish to be useable, feasible, and sustainable, and they plan to continue using the resources to improve maternal health care in their clinic.