Maternal Mental Health Screening Script
By the Policy Center for Maternal Mental Health
This script was developed to support the implementation of the Alliance for Innovation in Maternal Health (AIM) perinatal mental health recommendations and resources “bundle” and the American College of Obstetricians and Gynecologists (ACOG) perinatal mental health clinical practice guideline.
This script is designed for obstetric providers, the primary care provider during the perinatal period; however, the script can be adapted to other settings.
Recommended Citation:
Policy Center for Maternal Mental Health. (2024, April). Maternal Mental Health Screening Script https://www.2020mom.org/blog/2024/maternal-mental-health-screening-script
For screening to be effective, it requires trust between the patient and provider.
Studies have found that something as simple as explaining why screening questions are being asked and how screening information may be used (to help patients find the care they need and deserve) impacts a patient’s willingness to share sensitive information like anxiety or depressive symptoms.1
See “Preparing for Maternal Depression Screening” to review resources and ready your screeing team member(s).
Pre-Screen Script
The following script should be read/referred to for talking points as the screening team member explains why your practice screens:
“Our clinic cares about the well-being of the patients we serve. Maternal mental health disorders like postpartum depression and anxiety are the most common complications of pregnancy and birth
That’s why we screen all those expecting and in the postpartum period for these disorders using a simple questionnaire
Roughly 20% of mothers will suffer from these disorders, and help is available
[Insert position(s) or] [Our team] further assesses those who screen positive through a follow-up conversation, and together, we help devise a plan to get patients the help they need
The plan can include locating community-based support, like new parent groups and online support groups for depression and anxiety, to referral to behavioral health providers and/or medication, which we can generally prescribe here.
[If you are also supporting your patients through referral for social determinants of health support, like food and housing or childcare, note that here, too.]
Post Screen Script
PHQ-4 score greater than 3 for the first or last 2 questions, or 5 or higher
Total score ≥3 for first 2 questions suggests anxiety.
Total score ≥3 for last 2 questions suggests depression.
Thank you for answering these questions. Your screening score is elevated, and we want to help. To better understand how you might be feeling so we can get you the right type of help, please answer this additional questionnaire(s).
[Provide the PHQ-9 and/or GAD-7]
Depression: Negative
EPDS / PHQ-9 score 0-1
Thank you for answering these important questions.
I see your score is 5 or less, which means you haven’t expressed signs of depression.
Maternal depression can develop in pregnancy and through the first year postpartum, if you notice a change in your mood, please call us, and we will screen you again and help you get the help you need to feel well.
We will also rescreen you again [in pregnancy (screen 2xs during pregnancy), [or the postpartum period] in 90 days] to be sure your well-being is still strong.
In the meantime, to maintain your well-being as much as possible:
Try to exercise regularly (even 3 walks a week will help!)
Try to eat well - vegetables, fruits, and non-processed foods
Get outside/fresh air daily (even if just for 5 minutes)
Ask for help to prepare/care for the baby
Socialize with others you trust and enjoy being with and who acknowledge the changes that come with being pregnant/in the postpartum period. (Finding a birth class or mommy and me class can help you connect with those with due dates at around the same time as you. It’s helpful to have a network going through similar things as you!)
[Write these orders out, on a printout or script pad]
PHQ-4 score 0-1
Thank you for answering these important questions.
I see your score is 1 or less, which means you likely don’t have depression or anxiety right now.
Maternal depression and/or anxiety can develop in pregnancy and through the first year postpartum, if you notice a change in your mood, please call us, and we will screen you again and help you get the help you need to feel well.
We will also rescreen you again [in pregnancy (screen 2xs during pregnancy), [or the postpartum period] in 90 days] to be sure your well-being is still strong.
In the meantime, to maintain your well-being as much as possible:
Try to exercise regularly (even 3 walks a week will help!)
Try to eat well - vegetables, fruits, and non-processed foods
Get outside/fresh air daily (even if just for 5 minutes)
Ask for help to prepare for the baby
(Finding a birth class or mommy and me class can help you connect with those with due dates at around the same time as you. It’s helpful to have a network going through similar things as you!)
[Write these orders out, on a printout or script pad]
Depression: Negative but At Risk
EPDS / PHQ-9 score 2-5
Thank you for answering these important questions.
I see your score is x, which means you have shared some symptoms but don’t meet the threshold for depression.
Maternal depression can develop in pregnancy and through the first year postpartum, if you notice a change in your mood, please call us, and we will screen you again and help you get the help you need to feel well.
We will also rescreen you again [in pregnancy (screen 2xs during pregnancy), [or the postpartum period] in 90 days] to be sure your well-being is still strong.
In the meantime, to maintain your well-being as much as possible:
Try to exercise regularly (even 3 walks a week will help!)
Try to eat well - vegetables, fruits, and non-processed foods
Get outside/fresh air daily (even if just for 5 minutes)
Ask for help to prepare for the baby
(Finding a birth class or mommy and me class can help you connect with those with due dates at around the same time as you. It’s helpful to have a network going through similar things as you!)
[Write these orders out, on a printout or script pad]
PHQ-4 (Anxiety and Depression screener) score 0-1
Thank you for answering these important questions.
I see your score is 1 or less, which means you don’t likely have depression or anxiety right now.
Maternal depression and anxiety can develop in pregnancy and through the first year postpartum, if you notice a change in your mood, please call us, and we will screen you again and help you get the help you need to feel well.
We will also rescreen you again [in pregnancy (screen 2xs during pregnancy), [or the postpartum period] in 90 days] to be sure your well-being is still strong.
In the meantime, to maintain your well-being as much as possible:
Try to exercise regularly (even 3 walks a week will help!)
Try to eat well - vegetables, fruits, and non-processed foods
Get outside/fresh air daily (even if just for 5 minutes)
Ask for help to prepare for the baby
Socialize with others you trust and enjoy being with and who acknowledge the changes that come with being pregnant/in the postpartum period. Finding a birth class or mommy and me class can help you connect with those with due dates at around the same time as you. It’s helpful to have a network going through similar things as you!
[Write these orders out, on a printout or script pad]
Depression: Elevated (Mild)
EPDS / PHQ-9 score 5-9
Thank you for answering these questions.
I see your score is x, which is slightly elevated, so while you likely don’t have depression right now, you could be at risk.
In the meantime, let’s consider what your resources are to help improve your well-being as much as possible:
Try to exercise regularly (even 3 walks a week will help!)
Try to eat well - vegetables, fruits, and non-processed foods
Get outside/fresh air daily (even if just for 5 minutes)
Ask for help to prepare for the baby
Socialize with others you trust and enjoy being with and who acknowledge the changes that come with being pregnant/in the postpartum period. Finding a birth class or mommy and me class can help you connect with those with due dates at around the same time as you. It’s helpful to have a network going through similar things as you!
[Write these orders out, on a printout or script pad]
PHQ-9 or EPDS, 11 or higher
Anxiety, Negative:
EPDS No on Question 4 (Anxiety)
Q4. “I have been anxious or worried for no good reason”) which two studies found detected roughly two-thirds of those with identified anxiety disorders.
GAD-7 score 0-5
Thank you for answering these questions.
I see your score is 5 or less, which means you are not likely to have anxiety right now
However, your score is slightly elevated [if 2-4], so you could be at risk.
Maternal anxiety can develop at any time in pregnancy or throughout the first year postpartum, if you notice a change in your mood, you can call us, and we will screen you again.
We will also rescreen you at xx to be sure your well-being is still strong.
In the meantime, to maintain your well-being as much as possible:
Try to exercise regularly (even 3 walks a week will help!)
Try to eat well - vegetables, fruits, and non-processed foods
Get outside/fresh air daily (even if just for 5 minutes)
Ask for help to prepare for the baby
Socialize with others you trust and enjoy being with and who acknowledge the changes that come with being pregnant/in the postpartum period. Finding a birth class or mommy and me class can help you connect with those with due dates at around the same time as you. It’s helpful to have a network going through similar things as you!
Anxiety, Elevated:
EPDS Yes on Question 4 (Anxiety)
Q4. “I have been anxious or worried for no good reason”) which two studies found detected roughly two-thirds of those with identified anxiety disorders.
GAD-7 score of 6 or higher
Thank you for answering these questions.
I see your score is x or higher which means you are feeling anxious and are likely to have anxiety
We can help and recommend you find a mindful pregnancy/postpartum program
[One option is the evidence-based Pregnancy and Postpartum program through the Calm app with one-year free membership through Gerber however, please research support groups/programs in your community https://www.calm.com/blog/gerber-pregnancy-postpartum]
You can also see a therapist who supports maternal anxiety if you wish, you can find therapists by calling your insurance company and/or the national maternal mental health hotline, 1-833-TLC-Mama [provide palm card].
[If you have a list of local therapists printed, provide that too]
Elevated
GAD-7 score 6 or higher
(the higher the score, the more severe)
Your score indicates you are likely suffering from anxiety. We would like to help by getting you into a therapist who supports maternal anxiety and a support group. If your anxiety is having a big impact on your life, or therapy alone doesn’t help as much as we’d like, we can also consider medications [that are safe during pregnancy/lactation]. Antidepressants are first-choice options for managing maternal anxiety. There are other options we can consider later if these treatments haven’t worked for you in the past or these treatments don’t work the way we’d like them to. Prioritizing self-care, such as walking, lessening stress, and connecting with community resources can also help.
Can you think of 1-2 people you can ask for help to prepare/care for the baby?
Exercise can really help even though it’s really hard to think about when you don’t feel well. Do you have an exercise program you enjoy? Even a short walk every day will help. Getting your heart rate up and breaking a sweat is ideal.
Can you get outside to get fresh air daily, even if just for 5 minutes? This can really help.
Do you have access to healthy foods, like vegetables, fruits, and protein - non-processed foods?
Do you have others you trust and enjoy being with and who acknowledge the changes that come with being pregnant/in the postpartum period to connect with? (Finding a birth class or mommy and me class can help you connect with those with due dates at around the same time as you. It’s helpful to have a network going through similar things as you!)
[Write these orders out, on a printout or script pad]
PHQ-4 score greater than 3 for the first or last 2 questions, or 5 or higher
Total score ≥3 for first 2 questions suggests anxiety.
Total score ≥3 for last 2 questions suggests depression.
Thank you for answering these questions. Your screening score is elevated, and we want to help. To better understand how you might be feeling so we can get you the right type of help, please answer these two additional questionnaires.
[Provide the PHQ-9 and/or GAD-7]