Early Detection of Postpartum Depression: Evidence Based Risk Assessment Guidelines

Early detection of postpartum depression (PPD) is vital in improving maternal and newborn health.  PPD affects 10-20% of the postpartum women (Caple & Schub, 2011).  This project proposes guidelines for early identification of PPD by using evidence based risk assessment tools.  The needs assessment was performed in a postpartum unit of a suburban hospital, serving the community of Greater Houston, Texas.  Based on the Mental Health America (MHA) of Greater Houston 2007-2009 report, depression hits women in their childbearing age, especially between 25-44 years of age.  The children of mothers who had PPD are 4-times at risk for developing psychiatric illness compared to the children of mothers who did not have PPD (Neiman, Carter,Van Sell, & Kindred, 2010). PPD is a global issue. The international rate of PPD is consistent with the reported rate of 10-20 % in United States.  Examples of international reported rates are; Zimbabwe (16%), India (23%), Japan (17%), Italy (15%) (Becks et al., 2006).  The literature review provided an important look at risk factors for PPD.  Antenatal depression, antenatal anxiety, history of depressive illness, presence of any existing life stress, and level of self-esteem, the amount of social support available, marital or partner status, satisfaction with the marital relationship, undesirable or unintended pregnancy, socioeconomic stability, newborn characters and temper, child care stress, and presence of motherhood blues were recognized as the predictors of PPD (Beck, 2001; Beck et al., 2006).  In addition to the 13 substantial PPD risk factors identified by  Beck (2001), current or history of drug abuse (Ross & Dennis, 2009), and delivery of a premature or low birth weight baby (Vigod, Villegas,  Dennis, & Ross, 2010)  are significant with the target population. A close follow up patterns for those who are potential candidates for developing PPD is imperative (Beck et al., 2006).  Universal testing and evaluation of PPD is a standard of care in England, but not in United States (Caple & Schub, 2011).  Health care workers can support the mission of early assessment and screening for PPD, by learning and sharing information about PPD assessment and screening, educating the patient and asking about history of PPD or other risk factors, and administering a PPD screening tool for review (Caple & Schub, 2011). Health care workers need to be more active in educating patients, and community about PPD that affects marked number of women in the society (Schanie, Pinto-Foltz, & Logsdon, 2008).   Several researchers emphasized the need for early identification of women who are more likely to develop PPD after childbirth (Anderson, 2010; Neiman et al., Austin et al., 2008; Beck et al.,2006).  A routine antenatal psychosocial review may increase the provider's consciousness of psychosocial risk (Austin et al., 2008; Neiman et al., 2010).  An integrated approach with screening and intervention program in the obstetric settings will improve the help-seeking activities in PPD (Chen, Wang, Ch'ng, Mingoo, Lee, & Ong, 2011).  The review of literature supports the key role nurses play in assessing, and counseling women about PPD.  In addition, research supports the need to identify at risk groups early to initiate teaching, and therapy.  A checklist based on the PPD risk factors and EPDS may be helpful in identifying the women at risk for PPD. The literature review done for this project shows Edinburgh Postnatal Depression Scale (EPDS) is the valuable and a simple assessment tool for PPD risk assessment.  The primary investigator based on the literature review developed the part-1 (PPD Risk Factor Assessment Checklist) and part-2 (EPDS and PPD Screening) EBP guidelines for the proposal of in-patient PPD risk assessment guidelines.  The Beck's Postpartum Depression Theory guided the preparation of Evidence Based Practice (EBP) guidelines.  The Rogers' Diffusion of Innovations Theory will guide the implementation and evaluation process.