PIRIMID: A Clinician Decision Support System to Integrate Perinatal Depression E-Screening with Pathways to Care

The Parent-Infant Research Institute (PIRI) has developed a 4-step electronic clinical decision support system, PIRIMID (Perinatal Identification, Referral and Integrated Management for Improving Depression), designed to bridge the gap between perinatal depression screening and effective care.

PIRI is leading a cluster randomised controlled trial (c-RCT) beginning in 2020 in partnership with City of Whittlesea, Beyond Blue, PANDA and University of Melbourne. This trial will assess the acceptability and effectiveness of the PIRIMID tool in facilitating treatment uptake following screening for depression at postnatal Maternal and Child Health appointments.

PIRIMID consists of 4 steps to assist clinicians to develop a management plan.

Follow Steps 2 – 4: integrate EPDS results, risk factor results and other information to determine treatment options.

1 | The first screen on the clinician desktop shows the summary EPDS scores. On-screen prompts for interpretation of screening results and psychosocial information allow the user to consider the need to follow up e.g., risk assessment or diagnostic assessment for depression or anxiety. Alerts appear for women scoring high on the suicidality question. As screening tools cannot provide a definitive diagnosis or risk assessment, clinicians are prompted to follow up.
2 | PIRIMID provides a simple proforma and clinicians are prompted to enter pre-existing history and other clinical information so the information can be integrated with iCOPE screening results. On-the-spot access to gold-standard guidance for interpreting, and acting upon, screening results are provided via information bubbles, best practice procedures.
3 | PIRIMID’s evidence-based decision tree ensures adherence to National Perinatal Mental Health Clinical Guidelines.  The information gathered allows the clinician to put together the EPDS results with their own clinical information and further assessment required to create a structured management plan tailored to each client’s needs.
4 | Referral onwards. The PIRIMID management plan suggests what type of professional care is needed. PIRIMID also provides immediate links to e-mental health treatment: PIRI’s evidence based MumMoodBooster programs for pregnant and new mums available on MumSpace, funded through the Department of Health. Having selected the type of referral needed, many professionals will use their own preferred networks or refer using the e-Cope Directory.
PIRIMID provides a printable ready-to-use, simple, one page management plan that can be inserted in clinical notes or used for referral to a GP or other specialist.



Most mums who are identified as depressed are not treatedSixty percent of depressed perinatal women are not identified as depressed. Of the 40% whose depression is recognised, only 1 in 4 (10% of all depressed women) receive adequate treatment. Most women identified by screening are not connected with treatment pathways that result in recovery (see chart).
PIRIMID provides step-by-step guidance for pathways to care National roll-out of PIRIMID in tandem with screening Adherence to national perinatal mental health clinical guideline
PIRIMID piechart
Integrating screening & pathways to care is vitalScreening increases identification of perinatal depression but only reduces perinatal mental health morbidity when integrated effectively with pathways to evidence-based care.
locked onto back-end of iCOPE Ensures further assessment and referral to appropriate care Evidence-based decision tree
Assisting professionals to find the help mums needCoupling PIRIMID, a Clinical Decision Support System, with the iCOPE e-screening tool, will provide step-by-step guidance to ensure the best care pathway is found.

Summary EPDS scores, psychosocial information imported to clinician PIRIMID dashboard.

  • On screen alerts for high risk.
  • Guides clinician through next steps after screening.
  • Integrates clinical information and screening results.
  • Structured management plan tailored to each client’s care pathway.
  • Onward referral options