P2.G121: Sizing up the Screens: Comparing Perinatal Mental Health Screening Tools for Parents of Infants Hospitalized in Neonatal Intensive Care Units

Background: Parents in the Neonatal Intensive Care Unit (NICU) are at increased risk for perinatal mental health (MH) concerns, with as many as 45-50% experiencing clinically significant symptoms of depression or anxiety. The 2023 American Academy of Pediatrics neonatal standards of care include screening NICU parents for depression, yet there is minimal guidance on how and when to screen this population. Many protocols prioritize depression screening for gestational parents (GP) despite evidence that all parents are at risk and symptoms extend beyond depression. Additionally, there are many screening tools, and no single tool is recommended. The Edinburgh Postpartum Depression Scale (EPDS) is commonly used and validated for all parents; however a lower threshold has been proposed for non-gestational parents (NGP). Consequently, there is variability in screening practices, which may impact identification of MH concerns. We compared completion rate and percent positive for depression and anxiety when different screening tools were used.

Methods: Social work-led MH screening of parents whose infants remained hospitalized at 1, 2, 4, and 6 months (m) was implemented in two NICUs with similar patient populations (table 1) and protocols as part of a quality improvement project. Per institutional preferences, Site 1 (S1) used EPDS (threshold GP 10, NGP 8) with anxiety subscale (threshold 4) and Site 2 (S2) used PHQ-9 (threshold 10) and GAD-7 (threshold 5). Fisher’s exact test was used to compare results at 1 and 2m across a 5m screening period; 4 and 6m were excluded given lack of screens completed at S2.

Results: 75% and 61% of eligible parents were screened at S1 and S2 respectively. 35% screened positive for depression at 1m and 24% at 2m (S1) compared to 15% and 17% at 1m and 2m (S2). 43% of parents screened positive for anxiety at 1m and 30% at 2m (S1) compared to 39% at 1m and 50% at 2m (S2). Differences in positive depression screens were significant at 1m for NGP (S1>S2), however were not significant when a PHQ-9 threshold of 5 was used. The difference in number of screens completed between sites was statistically significant for total parent and NGP subgroups (S1>S2).

Conclusion: Our study aligns with previous research that EPDS may be preferred in this population given higher completion rate. Conclusions are limited by observational study design, screening team differences, and completion rate discrepancies. Differences in NICU environment may also contribute. Next, we have implemented EPDS with anxiety subscale at S2 to determine whether use of multiple tools and screening fatigue affects completion rate and percent positive. Further work is needed to determine best screening practices, including whether different strategies are needed for NGP, and should involve parent perspectives to ensure development of quality screening programs for this population.