Abstract

Background: Perinatal Mood and Anxiety Disorders (PMADs), including postpartum depression (PPD) are the number one complication of childbirth, with prevalence rates of approximately 7-15% in the US; however, rates as high as 40-60% for women living in poverty have been reported. Though validated screening tools and effective treatment exists, it is largely unrecognized and untreated. Consequences impact not only the mother but her infant as well and can have long term deleterious effects. Multiple poor obstetric outcomes have been reported due to untreated PMAD’s including: low attendance at prenatal care, preterm labor, low birth weight, maternal suicide, decreased breastfeeding rate, impaired maternal/infant bonding, and short and long term behavioral and cognitive issues for the child including social and language delays, impulsivity, and poor academic performance. Due to the significant public health sequalae, Butte County, California First 5 has identified PMAD’s as a critical maternal health focus area.

Methods: Based on a community needs assessment and a literature review, educational sessions were developed to increase screening and treatment of PPD within a rural health center in Northern California. During the four educational sessions, 32 providers and staff received information on PPD, instructions on screening with the Edinburg Postnatal Depression Scale (EPDS), triage/treatment guidelines, lactation safety information on common psychiatric medications, and community resources for PPD. Outcomes were measured by pre- and post- session surveys and by deidentified chart and referral data.

Outcomes: Of the 16 providers who completed post-surveys, 81% stated the sessions changed their PPD screening or treatment practices, and 100% found the information helpful. These sessions also resulted in a 133% increase in referrals for postpartum mental health issues. Integrating treatment into a preexisting home visitation program reduced evaluation and treatment waiting times from three to four months to seven to ten days, with a 97% breastfeeding continuation rate for women receiving treatment.

Conclusion: Building interdisciplinary triage/treatment pathways and holding educational sessions for providers and staff within a rural health clinic with strong lactation support services resulted in an increase in screening for PPD by obstetric and family practice providers and a decrease in waiting time for evaluation and treatment of affected women without an interruption in breastfeeding.

Keywords: Postpartum depression; PMAD; PPD; Screening; Rural health clinic