P3.D067: Provider Use and Comfortability with Standardized Maternal Mental Health Screening in a Large Pediatric Urban Academic Medical Center

Background: About 1 in 8 women experience postpartum depression. Untreated maternal depression can negatively impact not only their infant’s physical health but also motor, cognitive, language, social, emotional, and behavioral development. While women only have one scheduled postpartum visit, their child will have at least 7 visits in the first year, making pediatricians uniquely poised to provide screening and intervention for maternal depression. The aim of this study was to identify how frequently outpatient pediatric providers use the Edinburgh Postnatal Depression Scale (EPDS) and how comfortable they are using, interpreting, and providing next steps.

Methods: A 28-question survey was sent to pediatric trainees and outpatient pediatric providers at an urban health center and affiliated satellite location. Data was collected for 6 weeks. Five of the questions pertained to provider demographics and four assessed comfortability with EPDS screening, scoring, and management. Additionally, quantitative data on frequency of EPDS use was obtained from electronic health records (EHR) for well visits for patients 1 to 6 months of age. Frequency was determined by use of CPT billing code 96161 which is used to bill for administration of a caregiver-focused health risk assessment instrument.

Results: 35 providers completed the survey, with most respondents having 1-3 years of experience. The highest group of providers who did not use the EPDS was those with 1-5 years of experience (17.1%). Providers with >10 years of experience were more likely to use the EPDS screener >75% of the time (90%) as compared to those with 0-5 years experience (64%). Providers with 0-5 years experience more frequently felt very uncomfortable scoring the EPDS (11.4%) and providers with >10 years experience more frequently felt very comfortable (90%). Providers that tended to be comfortable scoring were also comfortable providing next steps (82.3%) and those that were uncomfortable scoring were also uncomfortable providing next steps (8.6%). EHR data showed that screening rates peaked at the 1-month visit, with screening only occurring at 67% of visits and decreasing with each subsequent encounter, only occurring at about 29% of 6-month visits.

Conclusion: Identifying and treating maternal depression is critical to infant development, well-being, and growth, and pediatricians are crucial in this process. This data showed that provider comfort with EPDS screening, scoring, and next steps increased with years in practice. In order to increase screening, training should target increasing provider exposure to EPDS to help bridge the gap that years of experience would provide. Limitations of this study include a small sample size which decreases the power of the study. Next steps include creating a curriculum to increase provider exposure in order to increase identification and support for mothers with postpartum depression.