657 - Screening Gaps: The Impact of Social Drivers of Health on Postpartum Depression Detection in a Level IV NICU

Publication Number: 4643.657

Gabriela Ulloa, Weill Cornell Medicine, New York, NY, United States; Emma Kane, New York Medical College, West Hartford, CT, United States; Priyanka Tiwari, Weill Cornell Medicine, Williston Park, NY, United States; Martha Liu, Weill Cornell Medical College, New York, NY, United States; Daniela Almonte, NewYork-Presbyterian Komansky Children’s Hospital, Bronx, NY, United States; Emily Echevarria, Weill Cornell Medicine, New York, NY, United States

Background: Postpartum depression (PPD) is a serious mental health disorder that occurs at high rates in Neonatal Intensive Care Unit (NICU) families. Adverse social drivers of health (SDoH) increase PPD risk and lead to inequalities in screening, diagnosis and treatment. Quality improvement (QI) may be used to improve PPD screening rates and treatment, but its impact on disparities is unclear.

Objective: To identify screening gaps and characterize SDoH risk factors for birthing parents in our urban Level IV NICU.

Design/Methods: A QI study was developed to improve PPD screening and referral rates for birthing parents in our NICU from 2024-2025. Screening occurred at 2, 6, and 12 weeks of admission with PHQ2 and EPDS as applicable. Demographic and SDoH data were collected from the electronic medical record then analyzed with Stata. Chi-square and Fisher's exact examined associations between screen approach and positivity rates and SDoH variables. Multivariable logistic regression evaluated the likelihood of undergoing PPD screening or receiving a positive screen result after adjusting for demographic and SDoH variables.

Results: Over 13 months, 449 birthing parents were eligible for screening, and 262 had demographic and SDoH data available for analysis. Patient characteristics, screening approach rates, and results are listed in Table 1. The screening approach rates were lower for birthing parents with primary language other than english (PLOE) at 44% compared to primary English speakers at 76% (p=0.004) and for birthing parents with Medicaid at 61% compared to those with commercial insurance at 77% (p=0.013), (Figure 1). In univariate data, birthing parents with PLOE (OR=0.26, 95% CI 0.1-0.68, p=0.006) and medicaid insurance status (OR 0.45, 95% CI 0.24-0.86, p=0.014) were associated with lower odds of screening approach (Table 2). Multivariable logistic regression models adjusted for PLOE, Medicaid, race, and ethnicity. PLOE continued to be associated with decreased approach rates (aOR 0.28, 95% CI 0.1-0.86, p=0.026), however insurance status lost statistical significance (Table 2). There were no significant differences in approach rates, PHQ-2 screening or positivity rates by race, ethnicity, infant gestational age, maternal age, primary language, and insurance type.

Conclusion(s): Medicaid status and PLOE were associated with significantly lower likelihood of PPD screening approach. Targeted strategies to improve equitability of mental health screening and care in QI is critical to optimize maternal and child health outcomes.

Table 1
Characteristics of eligible birthing parents divided into those approached vs. those not approached for PPD screening

Figure 1
Stacked Bar Chart displaying approach rate by language and insurance. X-axis displays the SDoH variable (primary language and insurance) and Y-axis displays percentage of birthing parents approached.

Table 2
Table displaying the logistic regression of SDoH variables associated with likelihood of approach for PPD screening including univariate odds ratios and multivariable adjusted odds ratios controlling for race, ethnicity, language, and insurance type