Depression Screening on a Maternity Unit: A Mixed-Methods Evaluation of Nurses’ Views and Implementation Strategies

Abstract

Postpartum women often suffer clinically significant depressive symptoms, a problem addressed by nurse-delivered screening programs. In the past, success of these identification programs was measured in terms of screening rates; however, merely evaluating the screening rate does little to inform how to implement depression screening in clinical practice. This article describes the experiences of nurses in implementing depression screening on a maternity unit. We evaluate the practice qualitatively, by asking nurses to describe their screening strategies and their views about implementation, as well as quantitatively by assessing their screening rates and the number of women identified. Utilizing a framework of program evaluation, 20 maternity unit nurses completed qualitative assessments investigating their day-to-day experiences with this practice. To include the perspectives of nurses that declined to participate in qualitative assessments, 14 additional maternity unit nurses completed a brief survey assessing their views. We also assessed screening rates, defined as the number of women screened divided by the number eligible for screening. Maternity unit nurses viewed depression screening positively and were able to screen patients in relatively few steps, which they implemented using strategies they had developed themselves. Despite nurses' ongoing concern about finding time to screen, they achieved high screening rates and, with one exception, indicated they would opt to continue voluntarily. Depression screening on the maternity unit is feasible and embraced by attending nurses. The clinical strategies used to implement screening are extensively described and provide a basis for implementation in other settings that serve perinatal women.

Perinatal depression screening in a Women, Infants, and Children (WIC) program: perception of feasibility and acceptability among a multidisciplinary staff

“…This theme was consistent with the previous literature that non-English-speaking individuals had lower probability of receiving the needed health care services [23], which would leave them in a more vulnerable position. This finding is consistent with depression screening in a Midwestern maternity unit where many nurses were concerned about cultural barriers and ability to understand the scale [24].…”

“…Research with family physicians and midwives finds that even though some physicians have adequate training and perceive the benefits of depression screening, they do not screen patients because of the perceived burden and lack of clarity on how to screen most effectively [27,31,32]. Notably, this gap in service provision is often ameliorated with time because the reservations to screen for depression diminish as providers develop familiarity with the tools and the process [24].…”

Social Support and Postpartum Depression Revisited: The Traditional Female Role as Moderator among Mexican Women

“…For many women, experiencing depressive symptoms during the third trimester carried into the postpartum, which underscores the continuity of depression during the perinatal period. Given this finding, practitioners need to expand prenatal screening of depressive symptoms and risk factors (Austin 2014; Bales et al 2015; Segre et al 2014). The use of the PHQ-9 measure in our study further corroborates the reliability and validity of using this brief and accessible measure to screen for depression (Kroenke et al 2001; NICE 2007).…”

A Nurse-Based Model of Psychosocial Support for Emotionally Distressed Mothers of Infants in the NICU

“…The first step would be to identify emotionally distressed women. Nurses in the NICU could incorporate universal depression screening, as was done by nurses who worked in the maternity unit (Segre, Pollack, Brock, Andrew, & O'Hara, 2014). As indicated in Figure 1, if the EPDS score is less than 12, the mother should be reassessed in accordance with the unit's depression screening protocol.…”