Postpartum depression (PPD) is a frequent complication of the postnatal period but remains underdetected in routine clinical practice. This prospective clinical study, conducted at the high-risk pregnancy clinic of the CHUM, aims to estimate the prevalence of PPD among patients seen in postpartum follow-up. It also assesses the feasibility of implementing a standardized screening protocol that combines the administration of the Edinburgh Postnatal Depression Scale (EPDS) with a clinical decision-support algorithm to guide appropriate medical follow-up. The study also seeks to explore clinical characteristics associated with higher EPDS scores.
Postpartum depression (PPD) is a common complication in the weeks following childbirth, with potential consequences for maternal health and early infant development. Although validated tools such as the Edinburgh Postnatal Depression Scale (EPDS) exist, systematic screening is not uniformly integrated into routine postpartum care. This prospective observational study aims to evaluate the implementation of a structured protocol for the identification and referral of postpartum depression in a high-risk obstetric population. The study will include 100 postpartum patients followed at the high-risk pregnancy clinic of the CHUM. All participants will be systematically screened for symptoms of postpartum depression using the EPDS during their scheduled postpartum visit. For patients with a score of 13 or higher, medical orientation will be guided by a standardized clinical algorithm that defines the recommended follow-up. Two follow-up telephone calls will be conducted, at two weeks and six weeks after the initial screening, to confirm whether the recommended referrals have been completed and to evaluate the time required to access appropriate services. The primary objective of the study is to estimate the prevalence of postpartum depression in this population. The secondary objective is to assess the feasibility of implementing a systematic screening protocol combined with a clinical algorithm to guide referral and follow-up. The study also seeks to explore clinical characteristics associated with elevated EPDS scores, including age, level of education, lifestyle habits (smoking, alcohol or drug consumption), psychiatric, medical and obstetric history (including history of miscarriage), mode of delivery and method of perinatal analgesia, breastfeeding, iron-deficiency anemia or iron deficiency, obstetric, anesthetic, or neonatal complications and skin-to-skin contact in the delivery room within the first 24 hours after birth.
Study Type
OBSERVATIONAL
Enrollment
100
Centre Hospitalier de l'Université de Montréal
Montreal, Quebec, Canada
Prevalence of postpartum depression in the study population
Proportion of patients with an EPDS score ≥13 at the 4 to 8-week postpartum visit. The Edimburgh Postnatal Depression Scale (EPDS) is a validated 10-item questionnaire designed to identify symptoms of depression in postnatal mothers. Each question asks about feelings and experiences over the past seven days, covering various emotional and psychological aspects related to perinatal mood. For each question, there are four possible responses, scored from 0 to 3, with higher numbers indicating more severe symptoms. The total EPDS score indicates the severity of potential depressive symptoms: a score of 13 or above often suggests a high risk of developing a depressive disorder.
Time frame: Baseline EPDS score (Day 0)
Orientation to a medical or psychosocial resource based on EPDS score and decision algorithm
Categorical outcome measuring the type of referral initiated following EPDS screening (e.g., pamphlet of information, primary care health services, psychiatrist, primary care physician, emergency department).
Time frame: Immediately after EPDS completion
Repeat EPDS score at 2-week follow-up (for scores between 13 and 16 only)
EPDS score collected by telephone at 2 weeks for patients with a Day 0 score between 13 and 16. Outcome measured as the proportion of patients whose score remains ≥13. The Edimburgh Postnatal Depression Scale (EPDS) is a validated 10-item questionnaire designed to identify symptoms of depression in postnatal mothers.
Time frame: 2 weeks after initial EPDS score
Number of days before the first contact with referred service
Number of days between the initial referral (Day 0) and confirmed access to the referred service (by patient report).
Time frame: Assessed at two-week and, if needed, six-week follow-up calls
Clinical and obstetrical factors associated with EPDS ≥13
Exploratory analysis to evaluate associations between an elevated EPDS score (≥13) and selected clinical variables, including age, level of education, lifestyle habits (smoking, alcohol or drug consumption), psychiatric, medical and obstetric history (including history of miscarriage), mode of delivery and method of perinatal analgesia, breastfeeding, iron-deficiency anemia or iron deficiency, obstetric, anesthetic, or neonatal complications, and skin-to-skin contact in the delivery room within the first 24 hours after birth.
Time frame: Chart review conducted following Day 0 visit and consent
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