Psychosocial assessment by phone for high-scoring patients taking the Edinburgh Postnatal Depression Scale: communication pathways and strategies

Abstract

The well-documented risks associated with perinatal depression provide a strong argument for universal screening. However, uncertainty about what to do with findings is a significant barrier to implementing screenings where obstetric care is provided. Based on experience with a comprehensive screening program, we describe a protocol for those critical communication pathways that encourage a dynamic phone exchange between a mental health caller and the patient who has scored in the high range on the Edinburgh Postnatal Depression Scale. In addition, we present guidelines for developing an action plan for addressing intervention needs and closing the feedback loop to the original administrators of the scale.

Can Postpartum Depression Be Managed in Pediatric Primary Care?

“…Suicide risks are examined as part of the most common screening tools (e.g., both EPDS and the Patient Health Questionnaire contain suicide items). Approximately half the programs identified specific crisis protocols for handling suicidality, 43,[52][53][54][55][56][57][58] with an emphasis in some for providers to be observant about the presence of rare but serious indicators of psychotic symptoms and thoughts of infant harm. 43,52 Only 5 of the 18 programs (28%) followed positive screens with a diagnostic confirmation.…”

“…Approximately half the programs identified specific crisis protocols for handling suicidality, 43,[52][53][54][55][56][57][58] with an emphasis in some for providers to be observant about the presence of rare but serious indicators of psychotic symptoms and thoughts of infant harm. 43,52 Only 5 of the 18 programs (28%) followed positive screens with a diagnostic confirmation. Three programs within PPC (Table 1) followed a positive screen with a structured psychiatric interview 54,59 or an additional tool to confirm diagnosis.…”

“…43,54,59 By contrast, all three ob-gyn settings monitored the treatment adherence of women who had positive screens. 51,52,56 Only two programs in PPC conducted child-level assessments. None of the programs in adult primary care or the generic toolkits recommended child assessment.…”

Evidence-Based Recommendations for Depressive Symptoms in Postpartum Women

“…In particular, evidence from experts supports the implementation of harm reduction methods especially with regard to a woman’s expression of self‐harm ideation. Regardless of the EPDS score, if a clinician is concerned about a women’s safety, it is more direct to inquire about her suicidal risk in a sensitive and respectful manner (Cardone, Kim, Gordon, Gordon, & Silver, 2006). Through a focused risk assessment, a skilled clinician can determine if the presenting behavior reflects psychopathology, contextual stressors, or a combination of both.…”