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Perinatal Depression Screening in the Pediatric Emergency Department
Naomi Abe1,2, Lukas Austin-Page1,2, Elizabeth Chang1,2
1Department of Pediatrics, University of California San Diego School of Medicine, La Jolla.
Insights
Pediatric emergency departments (PEDs) can identify parents with perinatal depression (PND) through screening. Many parents screened positive, highlighting the need for universal PND screening in PEDs.
Area of Science:
- Pediatric Emergency Medicine
- Maternal Mental Health
- Public Health Screening
Background:
- Perinatal depression (PND) is linked to increased child healthcare use.
- Current PND screening methods are suboptimal.
- Screening parents during infant visits to pediatric emergency departments (PEDs) may improve detection.
Purpose of the Study:
- To identify and characterize parents with positive PND screens in the PED.
- To assess the prevalence of PND screening in parents visiting the PED.
- To determine factors associated with positive PND screens and lack of prior screening.
Main Methods:
- Prospective survey study of parents with infants (<12 months) in a tertiary PED.
- Inclusion of English and Spanish-speaking parents; exclusion of those with infants requiring stabilization.
- Use of the Edinburgh Postnatal Depression Scale (EPDS) with a score of 10 considered positive.
Main Results:
- 27.7% of 452 parents screened positive for PND.
- Asian/Asian American parents and those with a history of mental health conditions were more likely to screen positive.
- One in three parents reported no prior PND screening, indicating a significant gap.
Conclusions:
- PED visits present a valuable opportunity for PND screening, especially for high-risk, previously unscreened parents.
- The high rate of positive screens across diverse parent groups supports universal screening in PEDs.
- There is an urgent need to address screening gaps and improve PND detection in this setting.
Objectives:
The optimal approach to perinatal depression (PND) screening is poorly understood. PND is associated with increased health care utilization in children. Parental PND screening during infant pediatric emergency department (PED) visits may improve detection. We aimed to identify and characterize parents in the PED with a positive PND screen and absent previous screening.
Methods:
We conducted a prospective survey study on a convenience sample of parents bringing their infants (<12 mo) to our tertiary PED from September to December 2022. We included parents with English or Spanish fluency. We excluded parents of infants who required medical stabilization. Participants completed a survey that included the Edinburgh Postnatal Depression Scale, a validated PND screen. A score of 10 was considered positive. We provided resources as appropriate. We used descriptive statistics, univariate analysis, and a generalized mixed effects model to identify factors associated with a positive screen and an absent previous screening.
Results:
Of 452 enrolled parents [387 (85.6%) females, 52 (11.5%) males], 125 (27.7%) screened positive. Gender was not associated with positive screening results. While Asian/Asian American parents and those with a history of mental health conditions or symptoms were more likely to screen positive, about 1 in 4 parents had a positive screen across all parent subgroups. One in 3 subjects reported no previous PND screening.
Conclusions:
PED visits offer a unique venue for PND screening, where high-risk parents who may otherwise go unscreened can be targeted. Our finding of a high proportion of positive screens across parent groups emphasizes the importance of universal screening in the PED setting. There is an urgent need to understand and improve the gaps in our current screening efforts.
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