Most new moms experience the “baby blues.” But some struggle with far worse. Peripartum depression (an inclusive term that includes postpartum depression) is defined by Johns Hopkins Guides as a “major depressive episode” that happens during pregnancy or within 12 months of delivery.
PPD symptoms can include significant anxiety, difficulty bonding with the infant, severe mood swings, poor sleep, and relationship difficulties. Most severely, PPD is also associated with suicide and suicidal ideation. Tragically, suicide is one of the leading causes of maternal mortality within 12 months of birth. There are also potential negative impacts to the infant, including reduced development of motor, cognitive, social, or emotional skills.
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PPD affects up to 20 percent of all women. Thanks to significant research initiatives and growing public awareness, hospitals and behavioral health organizations have improved their capacity to identify PPD and take measures to address symptoms early to improve outcomes for both the mother and infant. While the causes of PPD are not fully understood, we know that mothers shouldn’t be blamed for experiencing this illness.
But despite the growing awareness, PPD remains a significant factor in maternal mortality and maternal health outcomes overall.
Why untreated PPD remains so widespread
There is still not enough screening by acute care and behavioral care teams to diagnose PPD, and follow-up care is not always consistent.
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The Journal of Maternal-Fetal & Neonatal Medicine recently published a paper, which I co-authored, that examined current screening and training protocols around PPD. Study participants included about 800 clinicians and caregivers across acute care and behavioral health.
One positive finding was that about 97 percent of respondents said their organization has a specific PPD screening protocol. But only 70 percent said their care teams routinely screen for PPD – including just 32 percent in acute care settings and 13 percent in behavioral health settings. Additionally, 96 percent said that their care teams would benefit from additional training in how to screen and treat patients with PPD.
How to improve PPD outcomes
Hospitals and behavioral health organizations should take these steps to address the current training, screening and care gaps for PPD.
- Evaluate PPD risk assessment process. Through assessments and staff surveys, hospitals can better understand how care teams are currently assessing for PPD risk and how care is being delivered. Providers that identify knowledge gaps with clinicians and nurses may want to implement more frequent, comprehensive training in screening for PPD and establish a consistent process for outpatient referrals.
- Make standardized PPD screening universal. The American College of Obstetricians and Gynecologists (ACOG) recommends that all obstetric care providers use a standardized, validated tool to fully assess the emotional well-being and mood for each patient during postpartum visits. There are several validated screening tools available, including the Edinburgh Postnatal Depression Scale, which is the most frequently used screening tool in clinical settings. These tools generally ask the patient to report symptoms such as anxiety or sleep changes, which are used by clinical staff to determine if follow-up treatments are needed. Providers should most closely monitor women who have a history of mood disorders.
- Tighten up care protocols. While screening by itself can improve clinical outcomes by making patients aware of the warning signs, in the study we found a need for better follow-up care protocols for patients identified as being at risk for PPD. This includes better collaboration between acute care and behavioral care teams to refer patients to a mental health care provider and scheduling follow-up visits for patients diagnosed with PPD. It also includes conducting audits and quality checks to ensure that patients are receiving quality care.
- Understand the risk factors for PPD. Unfortunately, as ACOG notes, PPD disproportionately impacts people who lack social support; have lower incomes or lower education; are covered by Medicaid; or have been victims of domestic violence, among other factors. Perinatal care teams should be aware of these increased risk factors when screening patients.
Peripartum depression is still widely prevalent and represents one of the most critical maternal health risks. Fortunately, evidence-based interventions have been proven effective in mitigating PPD symptoms and improving health outcomes for both mother and infant. While obstetric care, acute care and behavioral health teams are better equipped than ever before to identify PPD risk, there is more work to be done. Hospitals and providers can be leaders in maternal health care by asking tough questions about their PPD assessment process and giving their staff the necessary training and tools to improve outcomes for patients suffering from PPD.
Photo: Arsenii Palivoda, Getty Images
Lora Sparkman, MHA, BSN, RN, is Partner, Clinical Solutions at Relias, trusted partner to more than 11,000 healthcare organizations and 4.5 million caregivers
