Date of Award

Summer 2025

Project Type

Thesis

College or School

CHHS

Department

Nursing

Departments (Collect)

Nursing

Program or Major

Clinical Nurse Leader

Degree Name

Master of Science

First Advisor

Pamela Kallmerten

Second Advisor

Jessica Bacon

Abstract

Abstract

Background: Perinatal mental health is a growing concern, with under identification and lack of access to mental health as contributing factors. Screening tools such as the Mood Disorder Questionnaire are one way to increase identification of patients at risk for bipolar-spectrum disorders and subsequent postpartum psychosis and initiate referrals to appropriate mental health services.

Local Problem: One outpatient women’s health center has a 94% screening rate for the Edinburgh Postnatal Depression Score (EPDS) for anxiety and depression but has not implemented a screening for bipolar disorder. In addition, while approximately one in five perinatal patients struggles with a mental health disorder, only 3.57% patients who are screened at eligible visits are referred to the integrated behavioral health team.

Methods: A quality improvement project was implemented in conjunction with the introduction of the Mood Disorder Questionnaire (MDQ) to screen for bipolar disorder symptoms and increase referrals to the behavioral health team. An educational presentation was the primary intervention, with a review the use of the MDQ and an associated referral workflow. In addition, steps were taken to integrate the MDQ into the electronic medical record to streamline the process for patients and staff.

Results: Chart reviews and data mining showed a pre-intervention screening rate of 94% for the EPDS and zero for the MDQ. Delays in the electronic medical record (EMR) integration process prevented the use of an electronic version of the MDQ and thus a study of this intervention was not conducted. EMR reports showed a pre-intervention referral rate of 3.57% and a post-intervention referral rate of 2.33%, with no improvement due to the EMR integration delay. However, provider confidence levels rose 93% for the use of the MDQ and 13% for the referral process following the educational presentation.

Conclusions: An educational presentation in conjunction with the introduction of a new mental health screening tool can increase provider confidence in using the tool and referring patients to appropriate services. The impact of the MDQ tool itself on the screening, identification and referral process could not be adequately assessed due to delays in the integration process.

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