Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program.
Purpose We describe results from a quality improvement project undertaken to address perinatal mental healthcare for women veterans. Description This quality improvement project was conducted in a single VA healthcare system between 2012 and 2015 and included screening for depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) three times during the perinatal period, a dedicated maternity care coordinator (MCC), an on-site clinical social worker, and an on-site obstetrician/gynecologist (Ob/gyn). Information on prior mental health diagnosis was collected by the MCC or Ob/gyn. The prevalence of perinatal depressive symptoms and receipt of mental healthcare among those with such symptoms are reported by presence of a pre-pregnancy mental health diagnosis. Assessment Of the 199 women who used VA maternity benefits between 2012 and 2015, 56% (n = 111) had at least one pre-pregnancy mental health diagnosis. Compared to those without a pre-pregnancy mental health diagnosis, those with such a diagnosis were more likely to be screened for perinatal depressive symptoms at least once (61.5% vs. 46.8%, p = 0.04). Prevalence of depressive symptoms was 46.7% among those with a pre-pregnancy mental health diagnosis and 19.2% among those without. Among those with a pre-pregnancy mental health diagnosis and depressive symptoms (n = 35), 88% received outpatient mental healthcare and 77% met with the clinical social worker. Among those without a pre-pregnancy mental health diagnosis and depressive symptoms (n = 8), none received outpatient mental healthcare, but 77.8% met with the clinical social worker. Conclusion Improving perinatal mental healthcare for women veterans requires a multidisciplinary approach, including on-site integrated mental healthcare.
US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development, 1660 S. Columbian, S-152, Seattle, WA, 98108, USA. jkaton@u.washington.edu.|VA Office of Patient Care Services, Women's Health Services, 810 Vermont Avenue, NW Washington, DC, 20420, USA. jkaton@u.washington.edu.|Department of Health Services, Magnuson Health Sciences Center, University of Washington School of Public Health, 1959 NE Pacific Street, Room H-680, Box 357660, Seattle, WA, 98195, USA. jkaton@u.washington.edu.
Jodie G
JG
Katon
VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.
Lacey
L
Lewis
VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.
Selma
S
Hercinovic
VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.|University of Utah Health Care, University Neuropsychiatric Institute, 501 Chipeta Way, Salt Lake City, UT, 84108, USA.
Amanda
A
McNab
US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development, 1660 S. Columbian, S-152, Seattle, WA, 98108, USA.|Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 4225 11th Avenue NE, Seattle, WA, 98105, USA.
John
J
Fortney
VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.|Department of Obstetrics and Gynecology, University of Utah Hospitals and Clinics, 50 North Medical Drive, Salt Lake City, UT, 84132, USA.
Susan M
SM
Rose
D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008603:Mental Health; D018743:Perinatal Care / Q000379:methods / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D058996:Quality Improvement; D012307:Risk Factors; D014728:Veterans / Q000523:psychology*
Perinatal depression; Perinatal mental healthcare; Pregnancy; Women veterans