Impact of Race, Insurance Status and Primary Language on Postpartum Depression Screening in a Level IV Neonatal Intensive Care Unit

This submission has open access
Submission ID :
ESPR475
Submission Type
Abstract: :

Background: Postpartum depression (PPD) is one of the most common complications of pregnancy and has detrimental effects on infants (1-3). Currently, the AAP recommends routine screening at well-child visits (1, 2). Neonatal Intensive Care Unit (NICU) and prematurity are independent risk factors for PPD, but formal screening recommendations are lacking (4-6). Black and Hispanic women have the highest rates of prematurity (7, 8) and being non-white and of lower socioeconomic status (SES) is associated with higher rates of PPD (5, 8-10). Few studies assessed screening rates in this high-risk population of women  and this study seeks to fill that gap (11). 


Objective: Identify differences in PPD screening completion rates and results in mothers of NICU patients based on race, insurance status and primary language at an urban level IV NICU.


Methods: Prior to this QI project, mothers in our NICU were referred for psychological support only if symptoms of PPD were subjectively noted by a member of the infant's team. This approach may have excluded  mothers who had fewer interactions with providers due to language and lower SES. This project involved a universal screening protocol using the Patient Health Questionnaire-2 (PHQ2) as the initial tool. All mothers of infants admitted to the NICU for >14 days were screened for PPD with PHQ-2 screens at regular intervals (2 weeks, 1 month (m), 2m, and 4m). Mothers with positive PHQ2 scores (≥2) were then administered an Edinburgh Postpartum Depression Screen (EPDS) and provided additional services if the EPDS was positive (>10). Charts were then reviewed for demographic data.  


Results: We screened 162 mothers for a total of 215 screens over 6 months. 83% of all eligible mothers completed the PHQ2. Of these screens, 84% of eligible white non-Hispanic women (n=92) were screened compared to 71% of Asian women (n=38; p = 0.1), 86% of black women (n=36; p=0.73) and 89% of Hispanic women (n=17, p=0.64). 84% of mothers who spoke English as a primary language (n=199) completed the PHQ2 screen as compared to 64% of non-English speaking mothers (n=14; p=0.061). PHQ2 completion rates did not differ based on insurance status [80% for Medicaid (n=59) and 84% for private insurance (n=156); p=0.45]. 10% of all PHQ2 screens were positive with 12% positive in white women and 6% in non-white women (p=0.17). 95% of women with a positive PHQ2 were screened with an EPDS, of which 48% were positive. Of those screened with an EPDS, 27% of white women had a positive EPDS (n=3) compared to 80% of non-white women (n=5; p <0.05). 


Conclusions: Screening rates between non-white and white women were not different. Although there was a trend toward increased screening in English-speaking women, this was not significant and suggests that this universal screening strategy was successful at reaching non-English speaking mothers. Finally, non-white women were significantly more likely to have a positive EPDS, which warrants further study. 

NYP Weill Cornell Medicine
New York Presbyterian- Weill Cornell Medicine
NYP Weill Cornell Medicine
NYP Weill Cornell Medicine
NYP Weill Cornell Medicine
NYP Weill Cornell Medicine
NYP Weill Cornell Medicine
NYP Weill Cornell Medicine
NYP Weill Cornell Medicine

Similar Abstracts by Type

Submission ID
Submission Title
Submission Topic
Submission Type
Corresponding Author
ESPR157
Clinical Research
Original science
Aditya Chhikara
ESPR302
Epidemiology
Original science
Natasha Jouk
ESPR74
Clinical Research
Original science
Alexandra Mazo
35 hits