Berger, Elizabeth A, DO

Curet, Sandra L, MD

Marraccini, Rory L, MD

Quiñones, Joanne, MD, MSCE

Smulian, Elizabeth A, BS

Smulian, John C, MD, MPH

Wu, Amy, BS

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Obstetrics & GynecologyThe Challenge of Early Inpatient PostpartumDepression ScreeningElizabeth A. Berger DOLehigh Valley Health Network, Elizabeth.Berger@lvhn.orgJohn C. Smulian MD, MPHLehigh Valley Health Network, john.smulian@lvhn.orgJoanne Quiñones MD, MSCELehigh Valley Health Network, Joanne_N.Quinones@lvhn.orgRory L. Marraccini MDLehigh Valley Health Network, Rory_L.Marraccini@lvhn.orgAmy Wu BSSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/obstetrics-gynecologyPart of the Obstetrics and Gynecology Commons, Psychiatry Commons, and the Statistics andProbability CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtBerger, E., Smulian, J., Quiñones, J., Marraccini, R., Wu, A., Smulian, E., & Curet, S. (2013). The challenge of early inpatient postpartumdepression screening. Poster presentation.AuthorsElizabeth A. Berger DO; John C. Smulian MD, MPH; Joanne Quiñones MD, MSCE; Rory L. MarracciniMD; Amy Wu BS; Elizabeth A. Smulian BS; and Sandra L. Curet MDThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/obstetrics-gynecology/2841Department of Obstetrics & Gynecology, Lehigh Valley Health Network, Allentown, PA; 2Division of Maternal Fetal Medicine, Lehigh Valley Health Network, Allentown, PA; 3Department of Psychiatry, Lehigh Valley Health Network, Allentown, PA; 4University of South Florida-Morsani College of Medicine,Tampa, FL; 5Emory University-Rollins School of Public Health, Atlanta, GA; 6Mental Health America of Georgia, Atlanta, GAThe Challenge of Early Inpatient Postpartum Depression ScreeningElizabeth Berger, MD1, John C. Smulian, MD, MPH1,2, Joanne N. Quiñones, MD, MSCE1,2, Rory Marraccini, MD3, Amy Wu, BS4, Elizabeth A. Smulian, BS5,6, Sandra Curet, MD1SURVEY 1•		To	determine	if	women	who	screen	positive	on	an	early	inpatient	Edinburgh	Postnatal	Depression	Scale	(EPDS)	have	a	specific	risk	factor	profile.	•		Assess	the	results	of	EPDS	screening	if	applied	to	a	risk-identified	population.	Objectives© 2013 Lehigh Valley Health NetworkConclusions•		This	is	a	retrospective	study	of	2	cohorts	of	women	delivering	from	1/2010	to	6/2010.	 	 	 –	Cohort1: A 5-week cohort of consecutive deliveries. 	 	 	 –		Cohort2: 5 months of consecutive deliveries from mothers with the most important risk factor for postpartum depression identified in Cohort 1, a history of mental illness.•		Screening	was	performed	prior	to	discharge.	•		An	EPDS	score	≥13	or	failure	to	answer	“never”	to	a	question	about	the	potential	for	self-harm	was	considered	positive.•		All	screen	positives	had	a	psychiatric	consultation.Methods•		Cohort	1	included	322	subjects	with	11(3.4%)	positive	screens.•		Cohort	2	included	215	subjects	with	33(15.3%)	positive	screens.		 	 	 –		Significant differences based on screen results in Table 1•		Multivariable	logistic	regression-identified	predictors	of	a	positive	screen:	 	 	 	 –		Cohort	1	(R2=0.44)	 	 	 	 	 •		A history of mental illness	 	 	 	 	 •		Neonatal infection	 	 	 	 	 •		Gestational diabetes	 	 	 	 	 •		Earlier EGA at delivery•		Diagnoses	from	psychiatric	evaluation	prior	to	discharge	results	in	Table	2.Results•		There	are	low	screen	positive	rates	for	population-based	EPDS	administration	prior	to	hospital	discharge.•		A	history	of	mental	illness	identifies	an	enriched	population	at	increased	risk	for	an	early	positive	screen.	•		Predictors	of	positive	screening	vary	based	on	the	population	screened.	•		Early	screening	prior	to	discharge	can	identify	a	variety	of	mental	health	disorders.	 	 –		Cohort	2	(R2=.14)	 	 	 	 	 •		Employment	 	 	 	 	 •		Vaginal delivery	 	 	 	 	 •		Gestational hypertensionTable 1. Significant	differences	between	those	women	who	screened	positive	using	the	EPDS	screening	tool	for	a	universally	screened	postpartum	group	(Cohort	1)	and	a	targeted	risk	population	with	a	history	of	mental	illness	(Cohort	2).Table 2. Significant	differences	between	those	women	who	screened	positive	using	the	EPDS	screening	tool	for	a	universally	screened	postpartum	group	(Cohort	1)	and	a	targeted	risk	population	with	a	history	of	mental	illness	(Cohort	2).            Cohort 1 (n=322) Cohort 2 (n=215) EPDS -n=311EPDS +n=11 PEPDS -n=182EPDS +n=33 PInsurance     Government    39% (73) 45.2% (14 0.05     Private    46% (86) 24.8% (8)       Self Pay    15% (28) 29.0% (9)  Employed    52.8% (92) 24% (7) 0.004BMI (mg/kg2)      Pre-pregnancy    27.6 + 8.6 26.3 + 6.7 0.08     Delivery    32.9 + 8.6 31.8 + 5.44 0.002EGA at Delivery (weeks) 38.7 + 2.6 34.7 + 5.6 <0.001  History of Mental Illness 14.1% (44) 63.6% (7) <0.001  Renal    1.6% (3) 0% 0.05Rheumatologic 1.0% (3) 9.1% (1) 0.02   GDM 9% (28) 27.3% (3) 0.04gHTN 5.9% (11) 16.1% (5) 0.04Neonatal 20.6% (64) 54.5% (6) 0.008AP/IP/PP/neonatal 71.1% (221) 100% (11) 0.04Vaginal Delivery 70.4% (218) 36.4% (4) 0.02 63.2% (115) 81.8% (27) 0.04NICU/Transitional Nursery 19.9% (62) 54.4% (6) 0.006            Cohort 1 (n=322) Cohort 2 (n=215) EPDS +n=11EPDS +n=33None 9.1% (11) -- (0)Major Depression 54.5% (6) 39.4% (13)Bipolar Disorder 27.3% (3) 24.2% (8)Substance Abuse 9.1% (1) 3.0% (1)PTSD 9.1% (1) 9.1% (3)Adjustment Disorder 9.1% (1) 21.1% (4)Generalized Anxiety Disorder -- (0) 3.0% (1)Panic Disorder -- (0) 6.1% (2)Anxiety Disorder (NOS) 27.3% (3) 3.0% (1)Mood Disorder (NOS) -- (0) 18.2% (6)Psychological Factors Affecting Medical Condition -- (0) 6.1% (2)No Diagnosis Assigned 9.1% (1) -- (0)1 Diagnosis Assigned 54.5% (6) 69.7% (23)2 Diagnoses Assigned 27.3% (3) 30.3% (10)3 Diagnoses Assigned 9.1% (1) -- (0)AP - Antepartum; IP - Intrapartum; PP - Postpartum

The Challenge of Early Inpatient Postpartum Depression Screening

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The Challenge of Early Inpatient Postpartum Depression Screening

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