123 - Enhancing Maternal Mental Health: A Quality Improvement Project Implementing Postpartum Depression Screening in a Level IV NICU

Publication Number: 4121.123

Emma Kane, New York Medical College, West Hartford, CT, United States; Gabriela Ulloa, Weill Cornell Medicine, New York, NY, United States; Emily Echevarria, Weill Cornell Medicine, New York, NY, United States; Martha Liu, Weill Cornell Medical College, New York, NY, United States; Priyanka Tiwari, Weill Cornell Medicine, Williston Park, NY, United States

Background: Postpartum depression (PPD) is a serious mental health condition that disproportionately affects birthing parents of infants admitted to the Neonatal Intensive Care Unit (NICU), with an estimated prevalence of 28-70%. PPD is associated with familial stress, negative parent-child interactions, and child developmental delays, making screening and treatment critical to optimizing outcomes. However, competing clinical demands and limited resources led to a lack of standardization in our NICU.

Objective: Our SMART aim is to increase our Patient Health Questionnaire-2 (PHQ-2) screening to 50% and increase appropriate mental health referral rates to 75% for birthing parents of infants hospitalized in our Level IV NICU.

Design/Methods: This quality improvement (QI) study utilized the Model for Improvement with three PDSA cycles. A process map with a two-tiered PPD screening process, an initial PHQ-2 at 2 weeks postpartum and subsequent Edinburgh Postnatal Depression Scale (EPDS), was implemented by a dedicated research team and social work (Figure 1). Mental health resources were offered to birthing parents who screened positive on the EPDS. Process measures included approach rates, PHQ-2 screening rates, and PHQ-2/EPDS positivity rates. Our outcome measure was referral rates. Our balancing measure was workload burden on staff. Statistical process control charts were used for analysis. Process improvement rules for special cause variation were applied.

Results: Over 13 months, 449 birthing parents were eligible for the PHQ-2, and 286 (64%) were approached for screening (Figure 2). Of those eligible, 148 (32%) completed the PHQ-2, reflecting screening barriers such as parental stress, time constraints, and limited research team follow-up. The PHQ-2 positivity rate was 9%, and 69% of those with positive screens were administered the EPDS. Failure to administer the EPDS was likely due to inaccessibility of the birthing parents. EPDS positivity rate was 89%. Of these, a mean of 88% were referred for treatment or had an established mental health care provider with a median of 100% (Figure 3). There were no center line shifts for our process and outcome measures.

Conclusion(s): Our QI project successfully connected birthing parents to mental health resources. Our PHQ-2 screening rate reveals a need to transition the workflow to our NICU nursing team given their availability at bedside and rapport with families. Our low PHQ2 positivity rate suggests a need for a more sensitive primary screening tool.

Figure 1
Process Map for PPD screening workflow.

Figure 2
P-chart displaying the approach rate of birthing parents for PPD screening. X-axis includes the number of birthing parents eligible to be screened per month/year. Arrows with PDSA cycle number indicate time of intervention. The solid line indicates the mean center line (CL). Dashed lines indicate upper control limit (UCL) and lower control limit (LCL).

Figure 3
Run chart displaying percentage of screened birthing parents with positive EPDS provided with a referral to or confirmed to have mental health resources. Arrows with PDSA cycle number indicate time of intervention. The solid line indicates the mean center line (CL). Dashed lines indicate upper control limit (UCL) and lower control limit (LCL).