Implementation of an Evidence-Based Postpartum Depression Screening Tool in a Level IV Neonatal Intensive Care Unit

Abstract

Problem: Postpartum depression (PPD) affects up to 40% of mothers with infants admitted to the Neonatal Intensive Care Unit (NICU), yet many remain undiagnosed due to the absence of standardized screening protocols. Early identification and referral to Perinatal Behavioral Health Services (PBHS) is critical to support maternal well-being and improve neonatal outcomes. Methods: This evidence-based quality improvement project utilized a descriptive and correlational design to evaluate the impact of implementing the Patient Health Questionnaire-8 (PHQ-8) for PPD screening among mothers of infants born ≤ 32 weeks’ gestation in a Level IV NICU. A convenience sample of 29 mothers received the PHQ-8 via phone at 48-hours and four-weeks postpartum. Referrals to PBHS were initiated for mothers who screened positive (PHQ-8 ≥ 5) and consented to a referral. Screening and referral rates were compared to retrospective pre-intervention data. Results: Among participants, 65.52% (n = 19) screened positive at either time point. Referral rates to PBHS significantly increased following PHQ-8 implementation (p = .001), with 14 mothers consenting to services. Six of ten mothers referred at 48-hours showed symptoms improvement by week four. While no significant change in overall screening positivity or severity was observed between time points, symptom fluctuation emphasized the importance of repeated screening. Implications for Practice: Routine use of the PHQ-8 in the NICU setting can increase identification of PPD and facilitate timely referral to PBHS. Integrating simple, validated screening tools into standard NICU workflows may address unmet mental health needs in high-risk mothers. Repeated assessments at multiple time points can enhance early intervention and promote long-term maternal-infant health