Routine screening for postpartum depression

BACKGROUND Postpartum depression (PPD) is a common and often overlooked condition. Validated screening tools fur PPD exist but are not commonly used. We present the 1-year outcome of a project to implement universal PPD screening at the 6-week postpartum visit. METHODS Universal screening with the Edinburgh Postnatal Depression Scale (EPDS) was implemented in all community postnatal care sites. One-year outcome assessments (diagnosis and treatment of PPD) were completed for a sample of the women screened using medical record review of all care they received during the first year postpartum. RESULTS Sixty-eight (20%) of the 342 women whose medical records were reviewed had been given a documented diagnosis of postpartum depression, resulting in an estimated population rate of 10.7%. Depression was diagnosed in 35% of the women with elevated EPDS scores (greater than or equal to 10) compared with 5% of the women with low EPDS scores (<10) in the first year postpartum. Treatment was provided For all women diagnosed with depression, including drug therapy for 49% and counseling for 78%. Four women were hospitalized for depression. Some degree of suicidal ideation nas noted on the EPDS by 48 women but acknowledged in the chart of only 10 women, including 1 with an immediate hospitalization The rate of diagnosis of postpartum depression in this community increased from 3.7% before the routine use of EPDS screening to 10.7% following screening. CONCLUSIONS A high EPDS score was predictive of a diagnosis of postpartum depression, and the implementation of routine EPDS screening at 6 weeks postpartum was associated with an increase in the rate: of diagnosed postpartum depression in this community.