Impact of midwives' training on postnatal depression screening in the first week post delivery: a quality improvement report

Background: postnatal depression (PND) is a major public health problem. The objective of this study was to improve early PND screening by midwives in a maternity unit. Professional screening techniques were evaluatedand compared with reference screening techniques [Edinburgh Postnatal Depression Scale (EPDS), Mini International Neuropsychiatric Interview (MINI-DSM-IV)]. Methods: the evaluation took place before and after the midwife training in order to determine the effectiveness of specific clinical recommendations for two successive 10-week inclusion periods (from November 2004 to September 2005). A short training course and posters were used to convey the recommendations, agreed by obstetricians, paediatricians and psychiatrists. Results: a total of 463 postpartum women were included in the two phases of the study. Quantitative and qualitative PN screening by midwives improved significantly following training (Z = 2.07, p = 0.04; Z = 2.62, p = 0.008, respectively). Early detection of major depressive episodes increased by 37.7% (95% confidence interval 25.7-49.7) following training. A combination of mid wives' perception of poor emotional well-being and the EPDS led to a significant improvement in early detection of PND (Q = 8.00, p = 0.04). Discussion: targeted recommendations given to the midwives led to an improvement in the early detection of PND. Suitable programmes need to be offered to reduce the number of cases of PND. Perinatal psychiatrists should be seen to be meticulous and available for such prevention action. (C) 2008 Elsevier Ltd. All rights reserved.