Section 2: PPD Screening During Texas Health Steps Checkups

How and when to screen

Establish your office protocol

  1. Determine when to conduct PPD screening.
  2. Select a validated screening tool like those listed below.
  3. Give each postpartum mother a printed or electronic screening tool to complete while she waits for her visit with the clinician. The screening tool should be completed by the woman herself. Questions should not be answered by anyone else on her behalf.
  4. Score the completed screening tool, using the standards provided for each tool, and assess whether the screen is positive or negative for PPD. The screening tool can be scored by a nonclinical staff member.
  5. The Texas Health Steps provider must review the screening results with the mother and discuss the possibility of depression and the impact it may have on the mother, family and health of the infant.
  6. If the mother screens positive for PPD, she and the Texas Health Steps provider should discuss options so the provider can make an appropriate referral.

Validated screening tools to be used for PPD screening during a Texas Health Steps checkup include but are not limited to:

Edinburgh Postnatal Depression Scale (EPDS)

A 10-item screening tool available in multiple languages that can be used free of charge with permission. A score of 10 or more suggests depressive symptoms. A score of 13 or more indicates a high likelihood of major depression. A score of 1 or more on question 10 is an automatic positive screen because it indicates possible suicidal ideation and requires immediate further evaluation.

Patient Health Questionnaire–9 (PHQ-9)

A 9-item screening tool available free of charge in multiple languages. A score of 10 or more indicates a high risk of having or developing depression. A score of 2 or more on question 9 is an automatic positive screen because it indicates possible suicidal ideation and requires immediate further evaluation.

Postpartum Depression Screening Scale (PPDS)

A 35-item self-report available for purchase. The tool takes 5-10 minutes to administer and is written at a 3rd grade reading level. A positive score identifies women who should be referred for definitive diagnosis and treatment.

Links to these validated screening tools are available in the Resources at the end of this course.

News you can use

Although rare, suicidal ideation and behavior may occur during any major depressive episode, including PPD. Risk factors include a prior suicide attempt or threat, single status, living alone and prominent feelings of hopelessness. Any woman who has a positive response to questions related to suicide on the PPD screening tool or who expresses suicidal thoughts should undergo a suicide risk assessment. A link to the Zero Suicide website, which includes helpful tools, is available in the Resources at the end of this course. Any mother who appears to be a risk to herself or her infant should be referred immediately for emergency evaluation or hospitalization.

Your next step depends on the results of the screening

  • Negative

    If there is a negative PPD screening result:
    • Discuss the results with the mother.
    • Educate the mother about signs and symptoms of PPD and how to seek help if needed.
    • Document the screening results in the infant’s medical record. (See the next page for required documentation.)
    • Provide health education and anticipatory guidance relevant to the infant’s age and development.
    • Schedule the infant’s next preventive medical checkup.
  • Positive

    If there is a positive PPD screening result:
    • Discuss the results with the mother.
    • Discuss the ways depression can affect her, her family and her infant.
    • Make a referral for additional evaluation or treatment. Provide a copy of the screening results.
    • Immediately refer for emergency evaluation and treatment in the case of suicidal ideation or behavior or signs of postpartum psychosis.
    • Provide support resources in the interim until the mother can access services.
    • Document the screening results and referral in the medical record. (See the next page for required documentation.)
    • Provide health education and anticipatory guidance relevant to the infant’s age and development.
    • Schedule the infant’s next preventive medical checkup.

Fast Fact

Anticipatory guidance is a required component of each Texas Health Steps preventive medical checkup. Providers are encouraged to address the topic of postpartum depression as an anticipatory guidance topic at each checkup up to the infant’s first birthday.