P2.F119: Depression Prevalence in a Fetal Care Center

Background: Diagnosis of a fetal anomaly during pregnancy is widely recognized to elicit psychological distress, negatively affecting the well-being of expectant parents. Despite this recognition, and the known impact of parents’ mental health on neonatal outcomes and parental coping/bereavement, there remains limited evidence regarding depression prevalence and additional risk factors in this demographic. To address this gap, we sought to quantify positive depression screening rates in a fetal care center (FCC) population and to identify characteristics associated with positive screenings and identify mental health referral uptake rates for patients screening positive.

Methods: We conducted a retrospective cohort study of 162 patients in a single large, mid-western FCC referred for pregnancies complicated by fetal anomalies. Screening for depression occurred at an antenatal visit subsequent to learning the fetal diagnosis. The Edinburgh Postnatal Depression Scale was utilized at both Clinical (≥10) and Research (≥13) thresholds. Data were analyzed using a series of multiple logistic regressions and included the characteristics of age, race, insurer, mental health history, primary language, travel distance, fetal diagnosis, and severity of fetal prognosis. Prognosis was stratified into the following categories based on neonatologist’s prediction of survival documented in the medical record: anticipated to survive, uncertain but likely to survive, uncertain (without qualifiers), uncertain but unlikely to survive, and non-survivable. The study was approved by the CMKC Institutional Review Board (protocol #00002636).

Results: Demographics of patients and frequency of positive screening are reported in Table 1. Patients in our cohort screened positive for depression at a rate of 31.9% at their first FCC screening. Characteristics associated with positive screening are reported in Table 2. Patients with a prior mental health diagnosis and those without private insurance or relying on state insurance were statistically significantly more likely to screen positive. Additionally, patients facing fetal diagnoses characterized by non-survivable prognosis, or having considerable prognostic uncertainty were more likely to screen positive for depression. Patients with positive depression screenings were likely to accept a counseling referral, with 74% (n=35) of patients scoring ≥10 and 93% (n=27) of patients scoring ≥13 accepting the referral. Only 17% of patients scoring ≥10 and 24% of patients scoring ≥13 accepted a referral for pharmacotherapy.

Conclusion: The findings highlight the substantial vulnerability of FCC patients to experiencing clinically significant symptoms of depression. Universal screening effectively identifies patients experiencing clinical levels of depressive symptoms, enabling prompt access to mental health support which patients were likely to accept. The findings also underscore the significance of fetal diagnosis and prognosis on expectant patients’ mental health. Particular attention should be provided around how to counsel, communicate with, and support patients with an uncertain prognosis or severe fetal diagnosis, particularly if they have a prior history of mental health diagnoses.