Perinatal mental health is a critical concern, with studies showing that up to 1 in 5 women suffer from maternal mental health disorders. Conditions like perinatal depression and anxiety can have severe consequences, affecting both mothers and their infants.
“A lot of my family and friends really struggled with postpartum depression,” shard Breslin Gillis, Psychiatric Mental Health Nurse Practitioner student at the college. “I also struggled, and I quickly realized there wasn’t a lot of help out there.”
Gillis recalls sitting in her providers office while she was stationed overseas for her and her husband’s job. She was freshly postpartum and in the trenches of newborn life. As she was crying her provider told her she was doing fine and dismissed her.
Despite the prevalence of these disorders, only 8.6 percent of perinatal individuals receive adequate treatment, contributing to high rates of pregnancy-related deaths. In Tennessee, maternal mental health disorders accounted for 32 percent of pregnancy-related or associated deaths in 2021, underscoring the need for better screening and intervention strategies.
Recognizing this issue, Gillis, sought out to find a solution. In partnership with The University of Tennessee Medical Center (UTMC) and local healthcare providers, she launched a phased project aimed at addressing perinatal depression and anxiety disorders (PMADs). The project, running from 2024 to 2026, focuses on improving mental health screening, diagnosis, and treatment for perinatal patients in the Knoxville area.
“When I returned to the states after our assignment ended, I began my DNP program,” shared Gillis. “As I began working in the clinical setting and talking with providers it became evident to us all that we needed more maternal mental health resources. That is what inspired this project.”
This five-phase initiative is a collaborative effort between DNP students from the college, the UT Medical Center for Women & Infants, UT Medical Center’s Women’s Care Group, and the UT Resident OB/GYN Clinic. Led by faculty members Tracy Brewer and Melissa Hessock, alongside Women’s Care Group PMAD OB/GYN expert, Dr. Heather Moss and Manager of Quality Review for the Center for Women & Infants, Megan Lacy Young, the project aims to improve the screening process for perinatal depression and anxiety at multiple stages of prenatal and postnatal care.
The first phase of the project was implemented in 2023 by Gillis.
In this phase, patients at 28 weeks of pregnancy were screened for depression and anxiety using the Edinburgh Postnatal Depression Scale (EPDS). The results revealed that over 80 percent of patients completed the EPDS screen, with 14 percent screening positive for depression and 26 percent for anxiety. Notably, 39 percent of those who screened positive had concurrent depression and anxiety diagnoses.
Despite these numbers, only 55.4 percent of patients with positive screens received behavioral health resources, highlighting the need for improved follow-up and provider documentation.
Building on the findings from Phase 1, the second phase, will expand the EPDS screening to the initial prenatal visit in addition to the 28-week visit. This phase will run until April 2025 and aims to increase early identification of mental health issues.
Additionally, Phase 2 will introduce screening for bipolar disorder at the initial prenatal visit using the Mood Disorder Questionnaire (MDQ), with plans to monitor screening rates and referrals for positive screens.
Starting in October 2024, the third phase, will focus on postpartum depression and anxiety screening. This phase will implement a standardized process for screening mothers before hospital discharge, ensuring those with positive screens are connected to behavioral health resources. Nursing staff will receive specialized training to enhance adherence to screening practices and ensure timely provider intervention for those who screen positive.
The later phases of the project will focus on expanding screening practices to more vulnerable populations. Phase 4, beginning in Spring 2025, will involve screening mothers whose infants are admitted to the NICU, while Phase 5 will implement mental health screening in the UT OB/GYN Resident Clinic starting in Fall 2025.
At the end of the project Gillis hopes that more resources become available and that there is a better integration of mental health providers in OB settings.
“The most rewarding aspect of this project is seeing the number of women we have already helped,” said Gillis. “Out of 366 patients eligible, 293 got screened. It is really rewarding because we helped people who needed it.”
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CONTACT:
Kara Clark (865-974-9498, [email protected])