Assessing Postpartum Depression in the Refugee Population in a Primary Care Setting

Abstract

Mental health is an area lacking emphasis in the United States healthcare systems. Many patients have suffered due to the decrease in focus and resources required to help individuals struggling with mental disorders (Lieberman, Goldman, Olfson, Pincus, & Sederer, 2017). While the struggle for adequate screening for mental illness continues, minority populations, such as refugee women, are affected more due to multifactorial risk factors and lack of treatment emphasis (Ganann, Sword, Thabane, Newbold & Black, 2016; Lieberman et al., 2017). Due to the increase in the number of refugees that migrate to the United States, particularly in the Midwest, healthcare providers must continue to enhance their knowledge on risk factors of mental illness in vulnerable populations, such as refugee women, and implement evidence-based practices that will promote the best possible patient outcomes. The practice improvement project aimed to increase healthcare provider awareness of the increased risk of postpartum depression (PPD) in refugee women compared to other patient populations and improve incidence rates of PPD during the first year of the postpartum period in refugee women. The project took place at a primary care clinic where the Edinburgh Postpartum Depression Scale (EPDS), an evidence-based screening tool for identifying risk for PPD, was implemented over a two-month period assessing for PPD. The results of EPDS were compared to the standard previously used Patient Health Questionnaire (PHQ-2) results over two months. A 30-minute educational session was given to the providers regarding how to assess for PPD, risk factors, providing culturally sensitive care, utilizing appropriate evidence-based screening tools for PPD, treatment options, and the results comparing the EPDS to the PHQ-2 implementation. Pre and post-survey evaluations were completed by the providers to evaluate the educational session and provider knowledge. Results indicated an increase in provider confidence and knowledge in assessing for PPD and caring for refugee women during the first year postpartum. The EPDS screening tool indicated PPD in more refugee women, suggesting the EPDS to be a more sensitive screening tool for PPD in refugee women when compared to the PHQ-2. The providers preferred to continue using the EPDS instead of the PHQ-2.