Screening for postpartum anxiety: A quality improvement project to promote the screening of women suffering in silence.
Sarah Toler, Susan Stapleton, Kim Kertsburg and 2 others
PMID 29684795WHAT IT FOUND
Screening postpartum women with a three-item anxiety scale caught 15 cases that depression screening alone missed.
Midwives found the tool easy to use but relied more on their own clinical judgement than the score.
Key findings
01Using the EPDS-3A anxiety subscale alongside standard depression screening identified 15 women (6.5%) with anxiety symptoms who would have been missed by depression screening alone.
02Midwives reported that the screening tool was easy to integrate into practice but frequently felt their established relationship with patients and clinical judgment were more valuable than the instrument.
03The project did not track whether women who screened positive actually received counselling, treatment, or referral, so the impact on patient outcomes is unknown.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a quality improvement project with no control group, so it cannot prove that screening improved patient outcomes. The study did not track whether women who screened positive received any follow-up care, treatment, or referral. Data came from a convenience sample of birth centres, mostly staffed by certified nurse-midwives, which limits generalisability to other maternity settings. There was no verification of the accuracy of the data entered into the registry. Midwives' feedback was analysed informally without rigorous qualitative methods, and many felt their clinical judgment was superior to the screening tool.
Declared interests
The authors declare no conflicts of interest. The project was supported by the American Association of Birth Centres.
The easy way to misread this
Do not assume that adding this screening tool automatically leads to better patient care. The study did not measure whether women who screened positive received treatment, and midwives reported that they often relied on clinical judgment over the tool's score.