Perinatal depression — defined as the occurrence of a major or minor depressive episode during pregnancy or up to 12 months after childbirth — affects as many as one in seven women.
It’s one of the most common complications of pregnancy, particularly among women of ethnic and racial minorities. The U.S. Preventive Services Task Force (USPSTF), an independent group of national experts, published a recommendation last week advising clinicians to provide or refer pregnant women who are at increased risk of perinatal depression — an umbrella term that encompasses postpartum depression (PPD), a more commonly known complication that occurs after childbirth — to counseling interventions.
While the recommendation is national in scope, Marcia Clevesy DNP, an assistant professor of nursing at UNLV, has been working since 2017 to improve the screening rates for PPD locally.
PPD is the most common complication after childbirth, but it is frequently undiagnosed and untreated because routine screening is not a standard of practice among most health care providers. With her work at a local clinic, Dr. Clevesy has focused on improving screening rates and documentation for PPD, while also advocating that all providers caring for maternal-child populations look for signs of maternal depression at the onset of pregnancy, and screen for it during the perinatal period. It is a project that has considerable regional and national implications.
We spoke with Dr. Clevesy to understand the importance of USPSTF’s newest recommendation and what this means for pregnant women and their providers.
Why is the new recommendation from the U.S. Preventive Services Task Force important?
It is important for a focus to be placed on detecting perinatal depression early on to prevent complications. The earlier we can identify maternal depression the better, because we are then able to get patients into therapy and treatment sooner.
The PPD diagnosis doesn’t necessarily mean that the patient has to take medications, however, identifying at-risk patients and screening them early prevents further complications and allows for treatment services before they escalate, which is crucial. In rare cases, women with perinatal depression may also want to harm themselves while they are pregnant.
Why now?
For the recommendation to come from the USPSTF is a significant statement.
The recommendations are becoming stronger now because depression and the importance of maternal mental health is becoming more ingrained in the national conversation. We have high-profile examples including celebrities and public figures who have been sharing their experiences with both depression and PPD, which allows women to feel more open to discussing their symptoms of depression.
We also live in a city where we care for many underserved populations. These patients are identified as being at a higher risk for having depression due to social circumstances, and/or lack of access to resources.
And the stakes are high, with suicide considered as a leading cause of maternal death during the postpartum period.
How are we addressing the treatment of PPD in Las Vegas?
I’ve been a women’s health nurse practitioner for many years, and want to continue to elevate the standard of PPD screening beyond simply asking patients if they’re depressed. In collaboration with Dr. Tricia Gatlin, associate dean for undergraduate affairs at the School of Nursing, I recently implemented a system for providers at a local clinic to use an existing, reliable and validated screening tool — the Edinburgh Postnatal Depression Scale (EPDS) — to screen for PPD as a means of promoting best practice among the maternal-child population.
It is a 10-question self survey and a score of 10 or greater is considered at risk for PPD, with the highest score being 30. This screening tool provides objective data that establishes a numerical value to determine the level of depression that the patient is demonstrating.
I feel that the use of a screening tool such as the EPDS conveys to the patient: “I care about your mental health,” and it opens up a further discussion and allows the patient an opportunity to openly communicate their feelings of depression.
Through this project initiative, PPD screening documentation rates at the clinic have increased from 56 percent to almost 93 percent, which is significant.
How can the medical community better assess and intervene in the treatment of PPD?
All health care professionals caring for the maternal-child population should be using a validated screening tool to measure PPD. There are several tools to choose from including the EPDS tool, Beck’s Depression Inventory, or the Patient Health Questionnaire (PHQ)-9.
One tool is not necessarily preferred over the other. What matters is that health care providers are using a validated tool to effectively screen and promote a discussion regarding depression symptoms. This assessment should start at the beginning of pregnancy and continue into the postpartum period.
While screening for depression may be uncomfortable for some health care providers and their patients, they are important discussions to have. Currently, the health care providers and staff at the clinic have continued to use the EPDS tool to effectively screen for PPD, and the hope is to promote this project initiative among all practices caring for the maternal-child population across Las Vegas. It is rewarding to see how beneficial this screening tool can improve the standard of care among the maternal population.
