How to Manage Positive App Screens for Perinatal Depression
How should clinicians respond when a smartphone-based postpartum depression assessment triggers concern for perinatal depression or suicidality?
Screening only helps if positive results reliably lead to contact, risk assessment, and a clear care pathway. This guide applies to postpartum patients whose smartphone responses raise concern for perinatal depression, self-harm, or other mental health needs requiring triage after screening.
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Define which app events trigger outreach
Generate nurse follow-up when a patient has an EPDS score of 12 or higher, endorses self-harm on EPDS question 10 regardless of total score, or requests a nurse phone call after scoring below 12. In this workflow, participants with EPDS scores below 12 were asked whether they wanted a phone call for any mental health concerns, and a yes response also triggered follow-up.
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Make same-day follow-up contact
Place the follow-up call on the same day the assessment is completed. During implementation, the app generated a notification to the nursing team immediately after the qualifying assessment response.
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Perform focused telephone risk assessment
During the call, gather additional information about the patient's mood assessment responses and psychiatric history and assess for active suicidal or homicidal ideation. Nurse calls in the study followed a physician-developed protocol to determine the most appropriate follow-up care or service linkage.
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Match the patient to the appropriate care pathway
Based on the nurse assessment and clinician discussion, classify the outcome as continued monitoring if no immediate intervention is needed or arrange active intervention when action is required. Documented actions in this workflow included clinic referral, emergency department referral, psychiatric hospitalization, lactation referral, and in-home wellness check.
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Place referrals through available clinical channels
Send referrals through the health system electronic medical record when possible, or contact the patient's outside treating clinician by phone if care is outside the system. When choosing the linkage, account for insurance status, geographic location, transportation access, and patient treatment preferences.
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Provide supplemental support resources
After the follow-up call, send relevant community-based resources for additional support. The app itself also included educational resources such as infographics, articles, and hotline phone numbers, and nonclinical supports like guided meditations or self-care reminders could be provided case by case when requested.
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Escalate unresolved safety concerns
If the EPDS score or the response to question 10 raises concern, have the nurse review the app responses with the physician lead and decide whether a wellness check is required. In this protocol, a wellness check meant notifying local law enforcement to go to the participant's home to verify safety.
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Repeat outreach before closing the case
If the patient does not answer, leave a voicemail and try again until 3 total contacts have been attempted. After 3 unsuccessful contacts, consider the patient lost to follow-up under this workflow.
Clinical Considerations
- Most app-triggered follow-up calls resulted in continued monitoring rather than immediate escalation, so a positive trigger did not automatically mean high-acuity intervention was necessary.
- A substantial proportion of participants were lost to follow-up or withdrew, which can limit how reliably this workflow reaches all patients who screen positive.
- Ninety participants could not be reached by phone following app-generated alerts despite the follow-up process.
- This was not a randomized controlled trial, so the study does not establish that this workflow is superior to traditional postpartum care.
Bottom Line
When an app flags possible perinatal depression or self-harm, same-day nurse outreach with structured risk assessment and predefined escalation pathways is the key step that turns screening into actual care linkage.
