Screening for postpartum anxiety: A quality improvement project to promote the screening of women suffering in silence

Abstract

Background: Postpartum anxiety is a mental health problem that has largely been ignored by maternity care providers despite an estimated incidence as high as 28.9%. Though postpartum anxiety may or may not be accompanied by depression, and while screening for postpartum depression has become more common place, postpartum anxiety is often not assessed or addressed.

Purpose: The purpose of this pilot quality improvement project was to implement a screening, treatment and referral program for postpartum anxiety in the birth centre environment.

Procedures: Midwives from 10 geographically diverse birth centres, and all members of the American Association of Birth Centres, were recruited to participate in the project. An online video was developed which detailed postpartum anxiety, screening through use of the anxiety subscale of the Edinburgh Postnatal Depression Scale and a toolkit for treatment and/or referral for screen positive patients. Participants entered patient scores into the Perinatal Data Registry of the American Association of Birth Centres. Individual interviews of midwives were conducted following the 10-week pilot period.

Main findings: There were a total of 387 participants across 9 participating sites. Among all screened participants with follow-up data, (n = 382), 9.69% (n = 37) were lost to follow-up. Among all participants screened with the Edinburgh Postpartum Depression Scale -3A and Edinburgh Postpartum Depression Scale (n = 318), 12.58% (n = 40) had a positive Edinburgh Postpartum Depression Scale -3A score of greater than six. Of all screened participants with an Edinburgh Postpartum Depression Scale score, 15 (6.98%) had a Edinburgh Postpartum Depression Scale score of less than 12 and an Edinburgh Postpartum Depression Scale -3A score greater than six, and would have not received follow up care if only screened for postpartum depression. Midwife participants expressed heightened awareness of the need to screen and felt screening was easy to integrate into clinical practice.

Conclusions: The Edinburgh Postpartum Depression Scale -3A is a valid, easy-to-use tool which should be considered for use in clinical practice. Modification of the electronic health record can serve as an important impetus triggering screening and treatment. It is important that clinicians are educated on the prevalence of postpartum anxiety, its risk factors, symptoms and implications.

Keywords: Postpartum anxiety; Postpartum depression; Postpartum mental health; Postpartum mood disorders; Postpartum period; Postpartum screening.

Fig. 1.

Stetler model of evidence-based practice to promote quality care. (Reprinted from Nursing Outlook, Vol. 49, Stetler, C. B., Updating the Stetler model of research utilization to facilitate evidence-based practice, pg. 272–279, copyright © 2001, with permission from Elsevier).

Fig. 2.

Patients who screened EPDS-3A positive by site (N = 318).