Postpartum depression (PPD) is the most common complication of childbirth, affecting up to 20 percent of all mothers. This figure may be even higher (up to 50 percent) among low-income and immigrant women.
The mood disorder can have significant implications for the mother, baby and the entire family. It can hinder mother-child bonding and lead to early discontinuation of breastfeeding, delayed immunizations, or in severe cases, child abuse and neglect.
Although new mothers are supposed to be screened routinely for PPD at postpartum visits with their maternal or pediatric health care providers, these screenings often don’t happen, either because doctors aren’t following the recommendations or parents aren’t attending these visits due to barriers to healthcare access or other issues.
According to a new study, providing PPD screening for new moms in the emergency department (ED) could help identify women suffering from the often debilitating disorder.
“The ED becomes the safety net for people who are not routinely accessing regular checkups for themselves and their children,” said Lenore Jarvis, M.D., M.Ed., emergency medicine specialist at Children’s National Health System in Washington, D.C. “If a mother is having an acute crisis in the middle of the night and feeling anxious and depressed, they often come to the emergency department for help.”
Jarvis and colleagues launched a pilot study in the Children’s ED to screen for PPD. For eight months beginning in June 2015, the researchers invited English- and Spanish-speaking mothers who came to the ED with infants 6 months old or younger with complaints that didn’t necessitate immediate emergency care to take a short questionnaire on a computer tablet.
The questionnaire included the Edinburgh Postnatal Depression Scale, a well-validated tool to screen for PPD, along with basic sociodemographic questions and questions about risk factors that other studies previously identified for PPD.
Just over half of the mothers (209 women) agreed to participate. When Jarvis and colleagues analyzed the results, they discovered that 27 percent scored positive for PPD, more than the average from previous estimates.
A total of 14 of these moms reported having suicidal thoughts. Surprisingly, nearly half of participants reported that they’d never been screened previously for PPD, despite standing recommendations for routine screenings at mother and baby care visits.
The findings are published in the journal Pediatric Emergency Care.
Based on the results of the study, the researchers implemented a range of interventions. All mothers who participated in the study were given an informational booklet from the March of Dimes on PPD.
If mothers scored positive for PPD, they also received a local PPD resource handout and were offered a consultation with a social worker. Those with a high score for PPD were required to consult with a social worker and were given the option of “warm-line” support to PPD community partners, a facilitated connection to providers who offer individual or group therapy or home visits, or to a psychiatrist who might prescribe medication.
Mothers with suicidal thoughts were evaluated by a physician and assisted by crisis intervention services, if needed.
At the one-month follow-up call with the PPD women, an overwhelming majority said that screening in the ED was important and that the resources they were given had been key for finding help. Many commented that even the screening process seemed like a helpful intervention.
“Some of these women had no idea how common PPD was. They thought they were crazy and felt alone and were bad moms,” Jarvis says. “For someone to even ask about PPD made these women aware that this exists, and it’s something people care about.”
Many of the moms thanked Jarvis and colleagues for the follow-up call, she adds, saying that it felt good to be cared for and checked on weeks later. “It goes to show that putting support systems in place for these new mothers is very important,” she says.
Currently, Jarvis and ED colleagues are collaborating with social workers, neonatology and other Children’s National care partners to begin a PPD screening process for mothers in the neonatal intensive care unit (NICU) and ED.
The researchers plan to compare the results of this universal screening to those in their study. These findings will help researchers better understand the prevalence of PPD in mothers with higher triage acuity levels and how general rates of PPD for mothers in the ED and NICU compare with those generated in past studies based on well-child checks.
Eventually, said Jarvis, they would like to investigate whether the interventions they prescribed affected the known consequences of PPD, such as breastfeeding, timely immunization rates and behavior outcomes.
“With appropriate care and resources,” Jarvis adds, “we’re hoping to improve the lives of these women and their families.”