New Peripartum Depression Study Shows Gap Between Screening and Outcomes

On Maternal Health Awareness Day, I would like to bring awareness to the publication of our peer-reviewed article in the Journal of Maternal-Fetal & Neonatal Medicine, “Improving maternal mental health: Assessing the extent of screening and training about peripartum depression.”

In this article, we examined results from our recent peripartum depression study, co-authored by researchers and clinicians at Relias. Elise Valdes, PhD, is the primary author; I am maternal patient safety lead; and my colleague, Rola Aamar, PhD, is one of the leads in behavioral health at Relias. Our study examined results of a survey of both acute care and behavioral health team members who worked with pregnant and post-pregnant patients.

We received nearly 800 responses from clinicians and caregivers, both in acute and behavioral health, about their peripartum depression (PPD) screening and care practices. The results indicated that a high percentage of respondents reported having a PPD training protocol at their organization. However, the results also suggested that most respondents also said they could use more education.

What is peripartum depression?

You may have previously heard the term postpartum depression. In this study, we used the term peripartum depression to more broadly encompass depression that occurs any time during pregnancy, up to four weeks after birth, or during the first 12 months after delivery. This definition is important when you consider that peripartum depression affects up to 20% of all women.

In addition to distress and difficulty for the mother, PPD can be associated with pregnancy complications, impaired maternal-infant bonding, and other negative consequences.

Impacts on the mother can include both physical and mental health effects, such as poor sleep, increased relationship difficulties, and the risk of suicidal ideation or suicide. In fact, suicide is a leading cause of maternal mortality in the first 12 months postpartum.

Babies may also experience negative health impacts from PPD, such impaired motor, cognitive, social, emotional, or language development. PPD can negatively affect bonding between mother and child, breastfeeding, and infant care.

Sadly, cases of PPD have often gone unrecognized, attributed to normal postpartum and pregnancy changes, or not reported at all. In our study, we noted that as few as 28% of women with PPD symptoms reported them to a healthcare provider.

My connection to peripartum depression

I’ve spoken previously about my connection to peripartum depression, both on the professional side and the personal side. I am a nurse with many years of clinical experience and now a vice president and partner in clinical solutions at Relias. My colleagues and I work to help improve maternal health outcomes by providing the best education and competency evaluation solutions for the healthcare workforce.

On the personal side, I want to raise awareness about the role that nurses and others play in effective screening and diagnosis for treating pregnant and post-pregnant women with PPD and PPD risks — and also, planning and arranging follow-up care or obtaining consultations prior to being discharged home.

My family and I were not aware of whether my niece, Brianne, was assessed for PPD or received care, diagnosis, treatment, or recommended follow-up care. She in fact did have PPD, and sadly, was not treated at all for two years post-delivery. We ultimately lost her to complications from PPD.

Our recent study and article aim to bring to light the fact that hospitals need to evaluate their PPD risk assessment process and take appropriate steps to treat patients and provide aftercare in their respective communities. Based on the rates of death related to maternal mental health issues, we believe there is a significant opportunity to improve PPD screening, diagnosis, treatment, and follow-up care.

How can we improve peripartum depression outcomes?

ACOG recommends that obstetric care providers screen patients once at a minimum for depression and anxiety using a standardized, validated tool. Screening should include a full assessment of emotional well-being as part of a comprehensive postpartum visit. Ideally, screenings for depression and anxiety should also occur during pregnancy.

ACOG stated that PPD is “one of the most common medical complications during pregnancy and the postpartum period.” It also emphasized that identification and treatment of PPD are important to avoid its potentially devastating effects.

Research cited in our study showed that screening occurred in less than two-thirds of mothers, with considerable variation depending on race, income-level, and Medicaid/Medicare status. Another study found delayed or nonexistent detection, and follow-up was as low as 17.9% on referrals for behavioral health care.

Providers should closely monitor women with a history of mood disorders, either prior to or during the perinatal period. ACOG notes that screening alone can benefit patients by raising awareness of warning signs and symptoms. However, standardized screening protocols, initiation of treatment, referral to a mental health care provider, and necessary follow-ups are critical for cases that might otherwise slip through the cracks.

New peripartum depression study findings

The Relias survey asked respondents for their perspectives about PPD screening. Questions covered related to training offered by their organization and their thoughts on whether their organization could benefit from additional training.

Specifically, respondents reported whether their care teams currently had a screening protocol for PPD. If so, it asked about their beliefs about the efficacy of their organization’s PPD screening, identification, and referral processes. Lastly, the survey asked whether respondents’ organizations currently offered or needed more training around the topic of PPD.

Positive findings

  • A very high number of respondents (96.7%) reported having a specific PPD screening protocol.
  • A very high number of respondents (93.3%) believed their organization does a good job screening for PPD.
  • A very high number of respondents (95.3%) reported that their organization gives training to those in contact with pregnant patients on screening, identifying, or treating PPD (or providing outpatient referrals)

Constructive findings

  • Despite the high numbers of respondents who reported having PPD screening and training practices within their organizations, only 69.6% reported that they routinely screen for PPD.
  • Only 32.2% of respondents in Acute care settings and only 12.9% in behavioral health settings reported screening all patients for PPD.
  • A high number of respondents (96.5%) reported that their organization would benefit from additional training in screening, identifying, or treating/referring patients with PPD.

Please see the study article for additional findings.

Peripartum study conclusions: What did we learn?

Because the study respondents voluntarily responded to our open call to participate, we can infer that they had an interest in PPD screening. They might have felt that PPD is an important issue and therefore were more likely to conduct PPD screening and seek training on the topic.

Even with a possible above-average interest in the topic among the study respondents, we saw much room for improvement in PPD screening and care. In general, perinatal care providers might be less inclined to screen or receive training, leading to even greater gaps in mental health care for patients in the U.S.

In addition, the study pointed to the need for acute care teams and behavioral care teams to work together to identify and treat PPD. It also suggested that pediatric care teams should screen new mothers at well-baby visits to identify possible latent cases. Further research could explore this area of need.

These new peripartum depression study results show that despite awareness about PPD and the use of screening protocols, practices are still inconsistent, and follow-up is uncertain in most cases. Care team members would benefit from more training, more consistent screening protocols, reduced variation in treatment, and better follow-up to ensure meaningful improvement in maternal behavioral health outcomes. These steps could save the lives of countless new mothers who struggle with PPD.

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Lora Sparkman

VP, Partner, Clinical Solutions, Patient Safety & Quality, Relias

Lora Sparkman, MHA, BSN, RN, is a clinical effectiveness consultant for Relias. She provides internal and external consulting, thought leadership, and strategic guidance on the use and optimization of Relias clinical solutions related to improving patient safety and creating high reliability in some of the highest risk areas in healthcare: Obstetrics and Emergency Department as well as other clinical areas with the acute care setting. Prior to Relias, Sparkman worked for Ascension as a director of clinical excellence. In her role, she had the opportunity to work with clinical leaders and innovators from across the country in improving the delivery of care, demonstrating results in patient outcomes, and reducing the cost of risk. Sparkman is a registered nurse, holds a Master of Health Administration from Lindenwood University, a Bachelor of Science in Nursing from the University of Missouri, and a Diploma in Nursing from Barnes Hospital School of Nursing.

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