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.
