Perinatal Mood and Anxiety Disorder Screening: Integrating Care Across Settings

Background: Perinatal mood and anxiety disorders (PMADs), including postpartum depression, are the most common complication of childbirth in the US and are associated with poor maternal, infant, and family outcomes. Identification and early intervention is imperative for successful PMAD treatment. Several professional societies recommend universal PMAD screening in outpatient visits. Objectives: To create a multidisciplinary PMAD collaboration among multiple hospital divisions to focus on systems change and health care policy solutions using evidence-based medicine. Methods: A Perinatal Mental Health (PMH) Taskforce was created to assess need for PMAD screening and strategize screening and integrative care hospital wide. Results: Primary care visit PMAD screening resulted in 10-15% of mothers screened positive. The pediatric emergency department (PED) serves as a safety-net for vulnerable, high-risk populations, and 27% of mothers screened positive in this setting. After adjustment for sociodemographic factors, PMAD-screened positive mothers also had increased PED utilization (aOR 1.29; 95% CI 1.03, 1.61). Further, PMADs disproportionately affect Neonatal Intensive Care Unit (NICU) parents as prematurity is a risk factor for PMADs. 45% of NICU mothers had a positive screen nearing discharge home. The PMH Taskforce applied lessons learned from department-specific screening initiatives to create a forum to discuss best practices and make hospital-wide recommendations. Through partnership with the DC Collaborative for Mental Health, PMAD screening in pediatric primary care is now reimbursed by DC’s Medicaid agency. PMAD screening has been expanded to 5 primary care locations throughout DC, which serve over 10,000 children ages 0-3. A PMAD Toolkit has been created and disseminated within the community. Screening for PMADs has now become incorporated into a hospital Corporate Goal. Results of our research and lessons learned have been disseminated through national scientific and lay press. The Taskforce further hopes to influence national and state health policy agenda, and its members have testified in governmental hearings. Conclusions: This innovative model can be scaled to promote rapid and effective change at other health systems. Foundational work has enabled us to build community bridges and break down internal barriers to shift our pediatric hospital towards prioritizing perinatal mental health. Through these efforts we aim to expand our program and partnerships to ensure that every mother gets appropriate care.