Publication: Improving Recognition of Postpartum Depression Using A Standardized PHQ-9 Score
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Date
2023-05
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Type
Capstone
Abstract
Current screenings for postpartum depression (PPD) lack evidence-based standardized guidelines regarding tools, frequency, and timing. A lack of consensus on critical PPD screening scores exists causing gaps in care regarding when to refer women for further mental health services. Providers indicate their schedule is too busy to conduct meaningful interviews with patients thus leading to lack of assessments all together. Gaps exist with implementation protocols as well as training for staff. The purpose of this study is to determine if identification of a patient with a Patient Health Questionnaire-9 (PHQ-9), set as the standard screening tool, of a score of ten or higher should receive a referral for mental health treatment. Furthermore, to disseminate a synthesis of evidence regarding screening for PPD to include suggested intervals of screening, and identification of at-risk patients who score high on the PHQ-9. The effects of PPD can extend long after the neonatal period, threatening the life of the mother-infant dyad if missed. Research indicates only twenty percent of women who screen high for PPD will actually obtain mental health services, even though by the year 2030 PPD is predicted to be the second largest health problem. Literature and evidence indicate that screenings completed within two days of birth are able to identify how likely a patient is to develop anxiety or depression up to a two to eight-week period postpartum. A comprehensive literature review was conducted and yields high level evidence recommending the use of the PHQ-9 as a widely validated tool for screening for depression in the perinatal setting. Compared to existing tools such as PHQ-2, WHO-5, and EPDS, evidence determined PHQ-9 to have the highest validity and reliability for screening against minor depressive symptoms. Strong evidence suggests a cutoff score of 10 and above for identification of depression. When applied to the perinatal population, a cutoff score of 10 is useful for clinicians to initiate referral. Implementing the PHQ-9 tool at standard intervals, 3 applying a standard cutoff score for referral and recognizing at-risk mothers for PPD will further decrease associated mortality with untreated PPD and improve the mother-infant bond.