改善住院产后抑郁症筛查：一项质量改进举措的结果

Improving inpatient postpartum depression screening: results from a quality improvement initiative.

作者信息

Woofter Rebecca, Hill Gwendolyn, Wong Emily, Bright Tiffani J, Bresee Catherine, Kilpatrick Sarah J, Accortt Eynav E

机构信息

Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.

Reproductive Psychology Program, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA.

出版信息

Arch Womens Ment Health. 2025 May 15. doi: 10.1007/s00737-025-01591-0.

DOI:10.1007/s00737-025-01591-0

PMID:40372532

Abstract

PURPOSE

Screening is necessary to identify patients with postpartum depression or anxiety and facilitate access to mental healthcare. This study evaluated a quality improvement initiative for inpatient postpartum depression screening, which was implemented to better identify patients in need of mental healthcare. This initiative replaced the Patient Health Questionnaire (PHQ-9) administered verbally by nurses with the Edinburgh Postnatal Depression Scale (EPDS-10) self-administered by patients via iPads.

METHODS

Electronic medical records for patients who delivered June 2020-October 2023 at Cedars-Sinai were analyzed (N = 17,403). Differences in completed screenings, positive depression screenings, suicidal ideation, and social work referrals before and after the initiative were examined with chi-square tests and multiple logistic regression models. Factors associated with positive anxiety screenings on the EPDS-10 were also identified.

RESULTS

Overall, 98.6% of patients completed depression screenings. Among those who completed screenings, positive depression screenings increased from 4.0 to 11.4%, identified suicidal ideation increased from 0.2 to 1.1%, and social work referrals increased from 64.1 to 84.0%, before and after the initiative. Post-initiative, patients had higher odds of positive depression screenings, indicating suicidal ideation, and receiving social work referrals compared to pre-initiative. Among those who completed EPDS-10 screenings, 31% were positive for anxiety.

CONCLUSIONS

Compared to the PHQ-9 administered verbally by nurses, the EPDS-10 self-administered by patients via iPads resulted in higher rates of positive depression screenings, identified suicidal ideation, and social work referrals. It is imperative to accurately screen patients for postpartum depression and anxiety to facilitate access to mental healthcare and address morbidity and mortality.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

目的

筛查对于识别产后抑郁或焦虑患者并促进其获得精神卫生保健至关重要。本研究评估了一项针对住院患者产后抑郁筛查的质量改进举措，该举措旨在更好地识别需要精神卫生保健的患者。此举措将护士口头实施的患者健康问卷（PHQ - 9）替换为患者通过iPad自行填写的爱丁堡产后抑郁量表（EPDS - 10）。

方法

分析了2020年6月至2023年10月在雪松西奈医疗中心分娩的患者的电子病历（N = 17403）。通过卡方检验和多元逻辑回归模型检查该举措前后完成筛查、抑郁筛查阳性、自杀意念和社会工作转诊情况的差异。还确定了与EPDS - 10焦虑筛查阳性相关的因素。

结果

总体而言，98.6%的患者完成了抑郁筛查。在完成筛查的患者中，该举措前后抑郁筛查阳性率从4.0%增至11.4%，识别出的自杀意念从0.2%增至1.1%，社会工作转诊从64.1%增至84.0%。举措实施后，与实施前相比，患者抑郁筛查阳性、表明有自杀意念以及接受社会工作转诊的几率更高。在完成EPDS - 10筛查的患者中，31%焦虑筛查呈阳性。