Screening for Postpartum Depression on an

Inpatient Unit

Poster Presentation

Background

Ten to 15% of women will experience postpar-

tum onset of a major depressive disorder yet

systematic screening is often neglected. The Edin-

burgh Postpartum Depression Screen (EPDS) is

widely available, easy to score, and has well estab-

lished reliability and validity. Review of the

postpartum depression (PPD) literature indicates

that the timing of onset may be highly variable, and

25% to 50% of cases may arise antenatally. Re-

search also demonstrates signi¢cant correlation

between EPDS scores administered in the early

postpartum period and a later EPDS screen.

Purpose

One objective of this study was to administer the

EPDS on the in-patient units of a large, Level 2 ter-

tiary care center during the immediate postpartum

period and compare the results of a 6-weeks re-

peated screen to examine correlations between

the two scores. A second objective of this study

was to validate a shorter two-question screen

adaptable to electronic record.

Methods

A convenience sample of patients who delivered vi-

able infants was given the EPDS, HRSA-UIC Screen,

and the Postpartum Depression Predictors Inven-

tory^R was given during in-patient stay. Patients

who screened high risk for PPD were provided with

a diagnostic interview by the in-patient mental

health service. All study participants were provided

with one of three levels of intervention based on

their EPDS score: routine counseling on PPD for

low risk scores, targeted counseling for intermedi-

ate risk scores, and a diagnostic interview with

referral or treatment for high risk scores. Six weeks

postpartum patients were sent a second EPDS to

return by mail.

Results

One hundred and ¢fty-nine completed the initial in-

patient screen of which 57% completed the second

screen at 6 weeks. The mean age of mothers was

26.8 years (SD 5 5.8) and 72% were White. Forty-

one percent of mothers had experienced depres-

sion prior to this pregnancy, and 36% had felt

depressed during this pregnancy. There were 24

(15%) new mothers that scored high risk on the in-

patient EPDS of which18 had a diagnostic interview.

At 6 weeks there were 18 mothers that scored as

high risk for PPD. The in-patient EPDS was signi¢-

cantly correlated to the 6-week (r 5 0.60, po.0001)

EPDS. Immediate postpartum EPDS and past his-

tory of depression were signi¢cant predictors of

PPD at 6 weeks (p 5 .0001 and p 5 .003, respec-

tively). Mothers that had an in-patient EPDS310

were 9.6 times more likely to score high risk at 6

weeks (95% CI 3.3, 28.6). The in-patient EPDS was

signi¢cantly correlated with the two-question

HRSA-UIC screen (r 5 0.52, po.0001). Fifty-nine

percent of the patients receiving a diagnostics inter-

view (EPDS310) had positive diagnosis of

depression.

Conclusions

The in-patient EPDS screen in the immediate post-

partum period was a signi¢cant predictor of

maternal mood at the 6-week interval. The two-

question HRSA-UIC screen had a signi¢cant corre-

lation with the EPDS and would be a reliable, more

concise screen that could be e⁄ciently incorpo-

rated into an intake history. Health care

professionals can use the EPDS in the immediate

postpartum period to evaluate new mothers for

depression so that interventions and referral can

be integrated into in-patient postpartum care.

Jocelyn Davis, MSN, DNP,

CNM, Staff Development,

Summa Health System, Akron

City Hospital Campus, Akron,

OH

JOGNN R E S E A R C H

Proceedings of the 2010 AWHONN Annual Convention

S102 & 2010 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses http://jognn.awhonn.org

Childbearing