A mother brings her infant to the emergency department (ED) in the middle of the night with a chief complaint of the baby being fussy. Nothing she does can stop the incessant crying, she tells the triage nurse. When doctors examine the baby, they do not see anything wrong. Often, this finding is reassuring. But, despite their best efforts to comfort her, the mother is not reassured and leaves the hospital feeling anxious and overwhelmed. The study was published online in Pediatric Emergency Care.

Postpartum depression

Postpartum depression (PPD) is the most common complication of childbirth, Dr. Jarvis explains, occurring in up to 20% of all mothers, and may be higher (up to 50 percent) in low-income and immigrant women. 

The associated effects on early brain development might cause cognitive and developmental delays for the infant and, later in life, can manifest as emotional and behavioral problems. PPD can disrupt relationships between parents. And suicide is the top cause of postpartum death.

Mothers are supposed to be screened routinely for PPD at postpartum visits with their maternal or pediatric healthcare providers. 

Emergency Department

One way to sidestep these challenges, she says, is to provide PPD screening in the emergency setting. The ED becomes the safety net for people who are not routinely accessing regular checkups for themselves and their children. If a mother is having an acute crisis in the middle of the night and feeling anxious and depressed, they often come to the emergency department for help.

Researchers analyzed the results from these 209 mothers, they found that 27% scored positive for PPD, more than the average from previous estimates. Fourteen of those mothers reported having suicidal thoughts. Surprisingly, nearly half of participants reported that they'd never been screened previously for PPD, despite standing recommendations for routine screenings at mother and baby care visits.

Based on the screening results, the researchers implemented a range of interventions. All mothers who participated in the study received an informational booklet from the March of Dimes on PPD. If mothers scored positive, they also received a local PPD resource handout and were offered a consultation with a social worker. 

Mothers with suicidal thoughts were assessed by a physician and assisted by crisis intervention services if needed. When the researchers followed up with mothers who screened positive one month later, an overwhelming majority said that screening in the ED was important and that the resources they were given had been key to finding help. Many commented that even the screening process seemed like a helpful intervention.

Some of these women had no idea how common PPD was. They thought they were crazy and felt alone and were bad moms. For someone to even ask about PPD made these women aware that this exists, and it's something people care about.

PPD Rates For Mothers

They plan to compare results generated by this universal screening to those in their study. These findings will help researchers better understand the prevalence of PPD in mothers with higher triage acuity levels and how general rates of PPD for mothers in the ED and NICU compare with those generated in past studies based on well-child checks.

With appropriate care and resources, they are hoping to improve the lives of these women and their families.