Targeting Postpartum Depression: An evaluation of the Edinburgh Postnatal Depression Scale in Pinellas County Florida - PowerPoint PPT Presentation

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Targeting Postpartum Depression: An evaluation of the Edinburgh Postnatal Depression Scale in Pinellas County Florida

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Targeting Postpartum Depression: An evaluation of the Edinburgh Postnatal Depression Scale in Pinellas County Florida Dorothy M. Miller, MSW, LCSW – PowerPoint PPT presentation

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Title: Targeting Postpartum Depression: An evaluation of the Edinburgh Postnatal Depression Scale in Pinellas County Florida


1
Targeting Postpartum Depression An evaluation
of the Edinburgh Postnatal Depression Scale in
Pinellas County Florida
  • Dorothy M. Miller, MSW, LCSW
  • Pinellas County Health Department

2
A Mothers Story

3
Background
  • 50-75 percent of all new mothers experience these
    feelings of sadness after birth
  • 1 in 10 new mothers experience various degrees of
    postpartum depression
  • Symptoms may occur
  • After childbirth
  • During pregnancy
  • After a miscarriage or termination
  • Up to a year or so after delivery

4
Objectives
  • Pinellas County Health Department began using
    Edinburgh Postnatal Depression Scale (EPDS) in
    the Fall of 2002 to determine
  • Number of pregnant and postpartum women screened
    positive
  • Major factors causing symptoms of depression
  • Referral process for clients receiving 12 or
    above on tool
  • Resources available to these clients
  • Barriers to mental health care

5
Methods
  • Edinburgh Postnatal Depression Scale (EPDS) (a
    short 10 question document) was selected as the
    screening tool
  • Care Coordinators were trained on administration
    and scoring of tool with a score of 12 or above
    warranting a mental health referral
  • The first 1270 screens completed were used as the
    sample for the evaluation/ 271 scored 12 or above
    and of those 247 were open and used as final
    sample
  • File reviews and interviews with caseworkers were
    conducted for additional data

6
Results
7
Demographics
  • Race
  • Asian .8(2)
  • Black 32 (79)
  • Native American .2(1)
  • White 67(165)
  • Age Average of 25
  • 13-17 years old 8.5 (21)
  • 18-24 years old 42.5 (105)
  • 25-35 years old 44.5 (110)
  • 35 years above 4.5 (11)

Overall majority of high scores are white women
between the ages of 18 and 35
8
Screen Administration
  • 40(99) during pre-natal period only
  • 33 (81) during postpartum only
  • 27 (67) at least twice (one prenatal/one
    postpartum)
  • Overall 60 (149) were screened during the
    postpartum period

9
Scores
  • 21 (271) scored 12 or above
  • Average Score 15
  • Clients first screens
  • 14 (35) scored 12
  • 54 (133) scored 13-17
  • 32 (79) scored 18 or higher

10
Changes in Scores
  • Of those screened pre-natally and postpartum
    (77)
  • 19 15 increased regardless of counseling
  • 47 36 decreased with minimum of 8 visits
  • 34 26 scored the same with counseling

11
Referrals and Compliance
  • 97 (240) received referrals to an outside
    facility/in-house mental health advocate
  • Of those 240, over half (131/55) completed an
    average of at least 8 weekly visits with a
    qualified mental health professional
  • 10 (25) of clients met with a provider once but
    did not comply a specified plan
  • 35 (84) refused any mental health services
    (reasons were as follows stigma, depression was
    situational, partner or parent refusal, schedule
    conflict)

12
Referrals and Compliance

13
Major areas of stress
  • 29 (71) presented with a mental health diagnosis
    or history of depression
  • All chose life issues as major problem
    finances, housing, transportation, education,
    child care, lack of insurance
  • About 20 had substance abuse problems
  • 10 had parenting/or childbirth related issues
  • 10 had domestic violence issues
  • 5 had DCF or other legal involvement

14
Barriers
  • Lack of Insurance
  • Language Issues
  • Social Stigma
  • Wait times
  • Schedule Conflicts
  • Spousal/Parental Refusal
  • Transportation

15
Insurance Coverage
Almost 50 of these clients lost medicaid
coverage during postpartum period
16
Conclusions
  • A significant percentage (21) screened 12 or
    higher verifying the need for more mental health
    services targeting this issue
  • The screening process should be more aggressive
    in capturing postpartum women it is important
    not to rely on a negative screen during pregnancy
    and repeat screen during post-natal period to
    rule out specific symptoms of postpartum
    depression

17
Conclusions
  • Approximately one-third of clients declined
    mental health services due to social stigma
  • There is a need for multi-cultural and bi-lingual
    services in the community
  • Medicaid dollars should be utilized to provide
    more in-house mental health services for these
    clients

18
Public Health Implications
  • This screen is a first step toward addressing
    the mental health needs of pregnant and
    postpartum women.
  • The results cannot be generalized but should
    encourage policy makers to mandate a universal
    tool for providers for early detection of these
    symptoms in women.

19
Public Health Implications
  • One in 10 new mothers experience some symptoms of
    depression. If left untreated, tragic outcomes
    could prevail for the babies and their mothers.
  • Screening provides a mechanism to detect symptoms
    and connect women to resources to prevent these
    types of outcomes.

20
Acknowledgements
  • Claude Dharamraj, MD,MPH
  • Patricia L. Ryder, MD, MPH
  • Jane Bambace, M Ed
  • Pinellas County Health Department, Community
    Health Division

21
Contact Information
  • Dorothy Miller, Pinellas County Health Department
  • (727) 824-6900 Ext 11323
  • Dorothy_Miller_at_doh.state.fl.us
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