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Primary Submission Category: Health care/services
Investigating the Quality of Perinatal Mental Health Screening and Referrals at a California Health System
Authors:Â Rebecca Woofter, Rashmi Rao, Courtney Thomas Tobin, Misty Richards, May Sudhinaraset,
Presenting Author: Rebecca Woofter*
Depression and anxiety are common during pregnancy and postpartum (the perinatal period). The American College of Obstetricians and Gynecologists recommends all perinatal patients be screened for mental health and referred to treatment as needed. Several states also mandate perinatal mental health screening. However, emerging literature suggests that perinatal patients are not satisfied with their screening and referral experience, and often cannot access desired mental healthcare. In this study, we investigate the quality of perinatal mental health screening and referrals and identify opportunities for improvement.
We conducted expert interviews with 21 obstetricians, labor and delivery nurses, and social workers within one California health system in 2023. During interviews, healthcare providers discussed their process for perinatal mental health screening and referrals, including any challenges they face and recommendations to improve the process. We used thematic analysis and a dual inductive-deductive approach to iteratively code interview transcripts and identify themes.
Preliminary findings suggest that obstetricians and nurses screen all patients for mental health using the Edinburgh Postnatal Depression Scale (EPDS). Providers find the EPDS useful, though note it does not necessarily capture all of patients’ symptoms. For those with high EPDS scores, obstetricians either give patients a list of mental health resources or refer patients to social workers who discuss treatment options and provide a standardized resource list. Obstetricians and social workers generally do not give patients tailored recommendations for mental healthcare nor assistance with making appointments. Obstetricians struggle with limited time to discuss mental health among other important topics during perinatal visits. Similarly, social workers have high caseloads of patients and limited time to speak with them. All providers emphasized the lack of available mental healthcare providers.