Abstract

Women in the United States most at risk for postpartum depression (PPD) are disproportionately impoverished racial/ethnic minorities. The prevalence of PPD increases from affecting 1 in 8 mothers in the nation compared to 1 in 3 mothers in low-income communities. Women from low-income neighbourhoods tend to face barriers to quality mental healthcare due to socio-economic challenges. At a home visiting clinic in Baltimore City, there have been lower numbers of positive depression screenings (9%) than referrals for mental health services for PPD (31.7%) (Showing a discrepancy between screening and referring for PPD). Given the vast effects of PPD clinicians should formulate a plan to decrease the rate of untreated PPD. This plan should include consistent screening for PPD until at least 12 months postpartum.

This quality improvement project was aimed to implement an evidence-based screening and referral process for PPD for women from low-income areas using the Patient Health Questionnaires (PHQ) 2 and 9.

This project occurred at a home visiting clinic over 14 weeks. Women ages 17-44 in a low-income area identified by U.S. census data. Staff education was conducted with the community health workers (CHW) on PPD and administering and scoring the PHQ-2 and PHQ-9. Women who were positively screened for PPD using the PHQ-2 (a score of two or more) were then screened with the PHQ-9. If the score of the PHQ-9 was four or higher (indicating mild depression), the woman received a direct referral for mental health services. Project data was collected on the data management spreadsheet using medical records audits. A run chart of the data was completed to identify trends.

100% of staff educated (18 staff members) before implementation. Fourteen percent (n=23) of clients screened positive for PPD. An increase of 64% compared to preimplantation rates. 100% of clients with a positive score had a referral for mental health services.

Results from this QI project demonstrated that routine depression screening of postpartum women can facilitate timely referral for mental health services. In the future, considering the target populations social determinants of health when administering postpartum depression screenings as well as staff education, training and check-ins may benefit similar clinics.