Introduction
Stillbirth is a profound event associated with elevated risks of depression, PTSD, and anxiety.1 However, pathways to psychiatric care after stillbirth are not well-studied. A retrospective chart review was conducted to describe follow-up patterns, depression screening after stillbirth, Edinburgh Postpartum Depression Scale (EPDS) scores before and after stillbirth, and resources offered to patients with EPDS ≥13.
Methods
This study was deemed exempt from Institutional Review Board (IRB) oversight (University of Michigan, December 9, 2024). Eligible charts were identified using Emerse and medical record review. Participants had a pregnancy loss at or after 20 weeks gestational age between 2021-2024 and received prenatal or postpartum care at Michigan Medicine. A total of 103 individuals met inclusion criteria. Demographic, medical history, follow up visits, and depression screening data from the 12 months post-loss were extracted. Descriptive analyses examined time to follow up and depression screening after stillbirth was conducted. Paired sample t-tests compared EPDS scores before and after stillbirth. For those with EPDS ≥13 post-loss, psychiatric resource usage was described.
Results
Sixty percent of patients in the sample did not complete a 2-week mood check and 20% were never screened for depression in the year after stillbirth. Among those screened before and after loss, 74.4% had a clinically significant increase in EPDS (≥4 points). The mean score change was +8.1 (95% CI 6.5-9.7, p < 0.0001). Forty-one percent had an EPDS ≥13 post-loss; of these, 97% received resources to support them with the most common being therapy (73%).
Conclusions
This study supports prior findings that patients who experience stillbirth are at higher risk for depression. Of the 52% of the sample who were screened before and after stillbirth, most experienced significant worsening of EPDS scores. Screening rates were low, with many patients lacking timely depression screening. Encouragingly, nearly all patients identified with elevated scores were offered resources. Future collaborative efforts between obstetric and psychiatric care providers could improve screening rates and ensure timely connection to appropriate care.
Tables and Figures
Figure 1. Summary of EPDS screening. In the left graph, the percentage of patients with an EPDS score above 13 in the postpartum year is shown. In the right graph, average pre- and post-loss scores are shown.
References
1. Westby, C. L., Erlandsen, A. R., Nilsen, S. A., Visted, E., & Thimm, J. C. (2021). Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review. BMC pregnancy and childbirth, 21(1), 782. https://doi.org/10.1186/s12884-021-04254-x