Doctor of Nursing Practice Inquiry Project Executive Summary Screening of Postpartum Depression and Stress among Mothers of Infants in a Pediatric Cardiovascular Intensive Care Unit: A Pilot Study

Problem Statement and Significance

Postpartum depression (PPD) is defined as depression after having a baby (CDC, 2020). According to a meta-analysis by Shorey et al. (2018), the prevalence of PPD among mothers with no previous history of depression to infants without congenital anomalies is 12%. PPD screening is recommended by the American Academy of Pediatrics (AAP) at 1-, 2-, 4-, and 6-month well-child visits (Earls et al., 2019). Mothers of hospitalized, critically ill infants may never see these routine well-child visits. Therefore, this is a missed opportunity to screen and refer mothers for postpartum depression within the hospital. 

            It is estimated that 11 to 18 percent of childbearing women suffer from PPD symptoms (AAP, 2019). The incidence increases up to 40 percent for mothers of children in the neonatal intensive care unit (NICU) (Vaughn & Hooper, 2020). Currently, PPD screening within a NICU is not considered the standard of care (Mounts, 2009; Hollen, 2018). According to Hynan et al. (2013), routine screening should be done in the NICU due to the potential trauma of having an infant hospitalized in the NICU.  PPD can have long-term consequences and affect the child, mother, and family’s health, finances, cognitive and social well-being (Earls et al., 2019). Recent research by the National Institutes of Health (2020) suggests that postpartum depression may persist up to 3 years after birth. The cost of maternal health care is 90% higher for those with PPD due to the use of mental health services and emergency room visits by both mother and child (Dagher et al., 2012). According to a meta-analysis by Slomian et al. (2017), PPD has negative consequences for the mother and the child until age three. Some of the negative effects include lack of mother-to-infant bonding, discontinuation of breastfeeding, increased infant health concerns, and decreased infant motor, language, social and emotional development (Slomian et al., 2017).  Research also indicates that 42% of children of mothers with PPD during the early postpartum period were evaluated as depressed themselves by the age of 16 (Murray et al., 2011, as cited in Hynan et al., 2020).

Mothers of neonates admitted to a NICU are a population at increased risk for PPD and stress. Mothers of fetuses with confirmed anomalies for which they will be hospitalized after birth are at increased risk for postpartum distress (Cole et al., 2018). In a study done by Solberg et al., 2011 severe congenital heart defects were a predictor of heightened symptoms of PPD. Parental stress due to their child’s admission to an intensive care unit (ICU) is expected; however, assessment of parental psychological status during ICU admission is limited. Still, screening, support, and referral may help minimize the traumatic reactions of parents and the possible adverse effects of those outcomes on children (Hynan et al.,2013). According to Miles et al. (1993), a NICU environment may be a significant factor that contributes to parent’s distress and can potentially affect parenting behaviors. This project aimed to develop a PPD screening program within the cardiovascular intensive care unit (CVICU). The main objectives of this project were to assess the utility, feasibility, and effectiveness of a PPD screening program in a busy CVICU.

Methodology

Design

This study was a pilot project to establish the utility and feasibility of a PPD screening program for mothers whose infants are admitted to a cardiac intensive care unit for a prolonged (>1 week) hospital stay.  This cross-sectional observational research study used survey methodology combined with descriptive data. 

The following variables were collected for each participant: 

Age, race, socioeconomic status, previous history of depression, the first eligible screening date for Edinburg Postnatal Depression Scale (EPDS) and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU), PSS: NICU scores, whether or not a recommendation for an obstetrician and gynecologist (OBGYN) was indicated, recommendation information given based on EPDS score PPD screening score, whether or not participant acted on the recommendation information provided by the research team (documentation of appointment made). In addition, if participants failed to obtain an appointment as indicated, barriers to scheduling this appointment were assessed. Furthermore, the following infant-related variables were collected: severity of the cardiac diagnosis and need for ECMO during current hospitalization. 

Setting and Population

Following institutional board review (IRB) approval from Purdue University and Indiana University, this study was conducted in