BOSTON — A standard-of-care toolkit designed to reduce the number of women with postpartum depression who go undiagnosed was described in a poster presented at the American Academy of Physician Assistants Impact 2014 meeting.

Melanie L. Williams, MPH, PA-S, of Emory University School of Medicine in Atlanta, Georgia, undertook a review of the postpartum protocol at Greater Atlanta Women’s Healthcare, an obstetrics/gynecology practice.

Although previous research has shown that women of lower socioeconomic status (SES) are more likely to develop depression, Williams discovered that the majority of patients diagnosed with postpartum depression (PPD) in this study had private insurance and had attained higher levels of education.

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Most of the diagnosed women had come to the office with a chief complaint of depression after having recognized changes in their own behavior.

“It is hypothesized and further reinforced through trends in the data analysis that this is due to their higher SES/education levels and that they were therefore more aware of PPD,” wrote Williams.

She added that this finding further highlights the existing disparity between the two populations in knowing when to seek help, as well as gaps in the office’s existing PPD screening methods.

Williams proposed a standard-of-care toolkit to educate patients about PPD and raise their awareness of the condition in hopes of increasing diagnosis rates and improving health outcomes for obstetrics patients. The toolkit includes:

  • Patient-education brochures to be handed out at the first prenatal visit to increase the patient’s awareness of the signs and symptoms of postpartum depression
  • The Edinburgh Postnatal Depression Scale (EPDS), a validated postpartum-depression screening tool
  • A Postpartum Support/Referral Network, including information on local perinatal and postpartum support resources
  • An implementation guide to help providers learn how to administer and score the EPDS and to prepare staff members for the new protocol

An algorithm for PPD

In addition to the toolkit, the researchers developed the following algorithm included in the poster, if there is any concern that the mother is suffering from postpartum depression, the clinician should assess the mother as guided by the acronym “SIG-E-CAPS.”

  • Evaluate for sleep disturbances
  • Interest reduction
  • Feelings of guilt and self-blame
  • Energy loss and fatigue
  • Concentration problems
  • Appetite change
  • Psychomotor changes in speech or movement
  • Suicidal thoughts or ideation

Clinicians can also use the EPDS to direct care. Women with an EPDS score of 4 or lower do not show signs of postpartum depression, but should be tested again during subsequent visits.

An EPDS score of 5 to 9 points indicates an increased risk for major depression – the clinician should inform women falling into this score range about the signs of depression. These women also should be given blank EPDS forms or access to the online version and be advised to come in for an appointment if their score exceeds a 9.

Women with an EPDS score of 10 or higher show signs of depression and require further evaluation or referral. The clinician should discuss with the woman the symptoms and diagnosis of depression as well as the treatment plan, help the woman obtain care, and give the woman contact information for suicide-prevention/depression hotlines.