761 Improving access to maternal mental health services for women with a positive postpartum depression screen

Abstract

Because perinatal depression can be detrimental to both women and their families, depression screening with adequate referral resources is an important access to care. We aimed to evaluate the utilization of mental health services (MHS) in an urban inner-city hospital following implementation of co-located MHS across ten community clinics serving a medically-underserved population. We hypothesized that integrating co-located MHS would improve referral rates following positive postpartum depression screening compared to before these services were deployed. This was a retrospective cohort study of women undergoing postpartum depression screening with deliveries from January 2017 to December 2019 compared to a historical cohort of referrals from the same population from June 2008 to March 2010. The Edinburgh Postnatal Depression Scale (EPDS) was universally administered to women at their postpartum visit and an MHS referral was offered for a score of greater than or equal to 13. The primary outcome was a comparison of completed MHS referrals between those with and without co-located MHS following a positive EPDS screen. Statistical analysis included chi-square with P<0.05 considered significant. In the study period, 25,425 women completed postpartum EPDS screening and 978 (4%) women had a +EPDS. The historical cohort consisted of 17,648 EPDS screened women with 1,106 (6%) with a +EPDS. Of those with a +EPDS that accepted referral, 238 (22%) in the historical cohort kept their referral visit compared to the contemporary cohort with 504 (52%) evaluations (P<0.001). Twenty-six percent of evaluations in the contemporary cohort were scheduled as virtual encounters with a 71% completion rate. Utilization of MHS following depression screening more than doubled following implementation of co-located services and implementation of virtual visits within the community clinic setting.