117 - Implementing a Perinatal Mood and Anxiety Disorders Screening Program in a Level IV NICU

Publication Number: 3111.117

Juan A. Gallegos, University of Texas at Austin Dell Medical School, Austin, TX, United States; Lisa Boyars, University of Texas at Austin Dell Medical School, Autsin, TX, United States; Kathryn Scott, Dell Children's Medical Center of Central Texas, Austin, TX, United States; Molly M. Pont, University of Texas at Austin Dell Medical School, Austin, TX, United States

Background: Maternal postpartum depression (PPD) and anxiety are major mental health concerns, affecting up to 40-50% of mothers with infants in the neonatal intensive care unit (NICU). Untreated symptoms can impair bonding, breastfeeding, neurodevelopment, and maternal well-being. While the American Academy of Pediatrics recommends PPD screening at well-child visits, prolonged NICU stays often delay these visits, increasing the risk for undiagnosed perinatal mood and anxiety disorders (PMAD).

Recognizing this gap, our team launched a quality improvement (QI) initiative to implement early PMAD screening for NICU mothers to facilitate timely identification and connection to mental health support.

Objective: Our SMART aim was to increase the percentage of mothers of infants admitted to Dell Children's NICU who are screened for depression and anxiety within the first 14 days of admission from a baseline of 0% to 50% by 6/1/2025. Our outcome measure was the proportion who completed the screening within 14 days of admission. The process measure was the proportion offered screening. Balancing measures included new referrals to the psychology and psychiatry caseloads.

Design/Methods: Multidisciplinary stakeholders identified four primary key drivers to guide change. A screening and referral protocol was developed using the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7). Screening was offered to mothers of infants expected to remain in the NICU for ≥14 days. Positive screens were referred to our NICU perinatal behavioral team. Plan-Do-Study-Act (PDSA) cycles guided iterative improvements to the process. Our outcome measure was tracked via a control chart. Our process measures were tracked via a run chart.

Results: A total of 216 mothers were eligible for screening. Since implementation, the proportion of completed screening within 14 days of admission increased from 0% to 52%. Overall, 70% of mothers completed screening at least once during admission. Ninety percent of eligible mothers were offered a screening. Among those screened, 13% had a positive PHQ-9 and 18% a positive GAD-7; 23% were referred to the perinatal behavioral team.

Conclusion(s): Our PMAD screening and referral program established a feasible process to identify and support maternal mental health needs in the NICU. More importantly, it's raised awareness of the mental health needs of families in high-stress environments, highlighting gaps in existing support. Future efforts will focus on standardizing communication to improve screening success and expanding the screening to multiple time points during hospitalization.

Proportion of Birthing Parents Screened within 14 days of NICU Admission
Control chart displaying the monthly proportion of eligible NICU mothers who completed depression and anxiety screening within 14 days of admission.

Screening Process Measures
Figure 2: Run chart showing the proportion of eligible mothers who completed screening at any point during their infants' NICU admission.
Figure 3: Run chart showing the proportion of eligible mothers who were offered a screening at any point during NICU admission.

Key Driver Diagram
Key driver diagram outlining the overall aim, primary drivers, and interventions used to implement early perinatal mood and anxiety disorders screening in our NICU.