(51 - Saturday) Screening of Postpartum Depression and Stress among Mothers of Infants in a Pediatric Cardiovascular Intensive Care Unit: A Pilot Study

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Abstract:

Introduction:
Postpartum depression (PPD) may have long-term consequences affecting the health and well-being of both mother and child. Infant critical illness increases the risk of PPD. There is limited data on the effectiveness and utility of PPD screening within a pediatric cardiovascular intensive care unit (CVICU).

Objectives: This pilot project aimed to test the feasibility, acceptability and potential effectiveness of a PPD screening program within a pediatric CVICU. Our secondary objective was to explore the relationship between PPD and hospital-induced stress.

Methods:

Design: Pilot implementation between April 2021 and September 2021
Patients: Inclusion criteria: mothers having a child < 1 year of age when admitted post-operatively to the CVICU. Exclusion criteria: non-English speaking, due to lack of translation services, mother’s age < 18 years old.
Sample size: Our main feasibility outcome goal was to attempt approaching no less than 90% of eligible mothers. To detect a difference of at least 10% from target (Cohen’s effect size -0.1), we estimated a sample size of 78. Allowing for missing or unusable data, we stopped once we reached 87 consecutive eligible mothers.
Setting: 18 bed CVICU in an academic children’s hospital
Interventions: We attempted to approach mothers between infant’s postoperative day 1 to 5. Mothers who agreed to participate were screened for PPD and stress using the Edinburg Postnatal Depression Scale (EPDS) and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU). All mothers who were approached received PPD education materials. Mothers who accepted screening were counseled on their results. For an EPDS ≥ 10, a recommendation was made to make an appointment with OBGYN, see a mental health provider, or attend a support group. The research team conducted a follow-up with all participating mothers within 1 to 2 weeks.

Results: We successfully approached 44 out of 87 eligible mothers (51%, 95% CI: 41, 61%) with the main reason for inability to approach being the mother being at bedside < 1 hour per day. 28 out of 44 approached accepted screening (63%, 95% CI: 48%, 76%) with the main reasons for refusal being feeling overwhelmed, doubting the utility of screening and time constraints. 11 out of 28 screened mothers (39%, 95% CI: 21%, 57%) were at risk for PPD, defined as EPDS score ≥10. Controlling for history of depression and socio-economic status, we found an association between a higher stress score and increased odds of a positive PPD screen (OR 2.2, 95% CI: 0.8, 7.4). 2 out of 11 mothers with a positive PPD screen were already being treated for PPD and 3 out of the remaining 9 (33%, 95% CI: 2%, 63%) obtained follow-up with an OBGYN or mental health provider.

Conclusions: In this pilot study, we were able to screen a third of eligible mothers whose infants were admitted postoperatively to the CVICU. To increase feasibility of screening, further iterations could include screening by bedside nursing and engaging a unit-based psychologist to increase the likelihood of successful referral. In this small sample, we found a positive PPD screen rate of 39% and a positive association between increased hospital-related stress and likelihood of a positive PPD screen.