(1171) The need for mental health screening and care at a high-risk fourth trimester clinic

To describe depression screening and referral to mental health (MH) services among high-risk individuals receiving care at a dedicated postpartum (PP) clinic within a racially and ethnically diverse urban health system and their associations with clinic referral indication.


Study Design:

An observational cohort of high-risk patients was followed for 12 months (6/2022 to 6/2023) at a specialized PP clinic where universal PP depression screening is performed at least once using the Edinburgh Postnatal Depression Scale (EDPS) as per clinic protocol. High-risk indications for clinic referral included a chronic medical condition and/or an adverse delivery or immediate PP event. All patients were offered referral to MH services regardless of their PP depression screen. Summary statistics described depression screening and referral to MH services. Chi-square test (p< 0.05) compared depression screen characteristics and MH referrals by clinic referral indication.


Results:

143 patients, 90.9% (n=130) of whom identify as non-white and 78.3% (n=112) of whom are publicly insured, were seen at our Fourth Trimester clinic. 87.4% (n=126) were screened for depression at least once. Among the 27% (n=34) who screened positive, 88.2% (n=30) were referred to MH services, 52.9% (n=18) of which attended an appointment. An additional 28 patients (19.6%) who screened negative for depression desired referral to MH services. Among those, 67.9% (n=19) attended at least one MH appointment. Performance of depression screening, positive screen prevalence, referral to MH services and attendance of a MH appointment were similar regardless of clinic referral indication.

Conclusion:

Over 25% of high-risk patients screened positive for depression and an additional 20% without positive screens desired MH referral. A standardized workflow including depression screening and universal referral to MH services can maximize identification of high-risk patients in need of mental health services.