387 - A Process for Screening for Perinatal Depression and Potential Suicidality Among Participants in an Infant Care Practices Study

Publication Number: 387.3959

Ann Kellams, University of Virginia, Charlottesville, VA, United States; Eve R.. Colson, WashU Medicine, Saint Louis, MO, United States; Fern R. Hauck, UVA, Charlottesville, VA, United States; Rachel Y. Moon, University of Virginia School of Medicine, Charlottesville, VA, United States; Rebecca F. Carlin, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Michael Corwin, Boston University, Mashpee, MA, United States; Stephen Kerr, BU, Boston, MA, United States; Fiona Rice, Boston University School of Medicine, boston, MA, United States; Nicole Geller, Boston University School of Medicine, Kings Park, NY, United States; Margaret Parker, UMass Memorial Children's Medical Center, Worchester, MA, United States

Background: Perinatal depression (PND), the occurrence of depression during pregnancy or postpartum, affects up to 1 in 7 people and can significantly impact parental ability to provide optimal infant care. Further, its toll on perinatal mortality is staggering, with almost 1 in 4 deaths attributed to mental health disorders. We thus included screening for PND in an infant safe sleep/breastfeeding education intervention trial.

Objective: To describe our process and outcomes for screening for PND and possible suicidality among study participants.

Design/Methods: The SMARTER (Social Media and Risk Reduction Teaching-Enhanced Reach) study is a 4-arm RCT in which 2000 pregnant English- and Spanish-speaking participants are recruited through WIC and Federally Qualified Health Centers in 17 states and randomly assigned to safe sleep or breastfeeding mobile health interventions during pregnancy and postpartum. Participants who screen positive on the PHQ-4 on the baseline, birth or postnatal survey complete the Edinburgh Postnatal Depression Scale (EPDS). Responding anything but “never” to question 10 about thoughts of self-harm in the past 7 days triggers a protocol initiated within 72h that includes up to 3 phone attempts by a study clinician to reach the participant, unless she opts out (this option began in 12/23). Spanish interpreters are used if indicated. Resources for mental health support are provided. Information is shared among staff using secure email.

Results: 3176 surveys were completed; 683 (21.5%) were positive screens on the PHQ-4 and responded to the EPDS. 112 (3.5% of total surveys) had a response other than “never” to the self-harm question and qualified for a call; 11 participants qualified on 2 surveys. Prior to the opt-out option, we reached 33 (57.9%) of 57 participants whom we tried to contact. After implementation of the opt-out option, we reached 23 (41.8%) of 55 participants, and 18 (32.7%) opted out. Mothers were overall appreciative of our calls; most were already receiving some mental health support. Our clinicians provided information about resources and enjoyed the direct contact with participants.

Conclusion(s): Many researchers perceive the burden of assessing for PND and safety to be so high as to be impractical. Screening for PND and administering the EPDS is feasible for the research team and acceptable to participants. Screening for PND and potential suicidality in applicable studies provides an opportunity to identify a serious, highly prevalent condition and provide resources for those who may otherwise be unaware of them.