Development and Implementation of a Postpartum Depression Screening Program in the NICU

Comparative analysis of machine learning versus traditional method for early detection of parental depression symptoms in the NICU

Introduction

Neonatal intensive care unit (NICU) admission is a stressful experience for parents. NICU parents are twice at risk of depression symptoms compared to the general birthing population. Parental mental health problems have harmful long-term effects on both parents and infants. Timely screening and treatment can reduce these negative consequences.

Objective

Our objective is to compare the performance of the traditional logistic regression with other machine learning (ML) models in identifying parents who are more likely to have depression symptoms to prioritize screening of at-risk parents. We used data obtained from parents of infants discharged from the NICU at Children's National Hospital (n = 300) from 2016 to 2017. This dataset includes a comprehensive list of demographic characteristics, depression and stress symptoms, social support, and parent/infant factors.

Study design

Our study design optimized eight ML algorithms - Logistic Regression, Support Vector Machine, Decision Tree, Random Forest, XGBoost, Naïve Bayes, K-Nearest Neighbor, and Artificial Neural Network - to identify the main risk factors associated with parental depression. We compared models based on the area under the receiver operating characteristic curve (AUC), positive predicted value (PPV), sensitivity, and F-score.

Results

The results showed that all eight models achieved an AUC above 0.8, suggesting that the logistic regression-based model's performance is comparable to other common ML models.

Conclusion

Logistic regression is effective in identifying parents at risk of depression for targeted screening with a performance comparable to common ML-based models.

Improving Maternal Depression Screening in the Neonatal Intensive Care Unit

PURPOSE

To examine whether self-perceived benefits of mental health treatment differed between mothers of babies in the neonatal intensive care unit with and without a positive screen for depression based on their Edinburgh Postnatal Depression score.

STUDY DESIGN AND METHODS

Mothers were recruited in person pre-COVID-19 pandemic, and via phone call and online advertisement during the pandemic. Mothers completed a 10-item depression scale and whether they believed they would benefit from mental health treatment. A chi-square test determined the difference in perceived benefit between mothers who screened positively for depression and those who did not.

RESULTS

This secondary analysis included 205 mothers, with an average age of 29. Of the 68 mothers who screened positively for depression, 12 believed that would not benefit from mental health intervention. Of the 137 who screened negatively for depression, 18 believed they would benefit from mental health intervention. Mothers who screened negatively for depression were significantly less likely to believe they would benefit from mental health intervention.

CLINICAL IMPLICATIONS

Depression screening scales offer guidance on which mothers to flag for follow-up, but neither on how a mother will respond nor how to effectively approach a mother about her mental health. Nurses can improve identification and follow-up of depressed mothers in the neonatal intensive care unit by asking mothers about their perceived need for mental health treatment.

NICU Visitation Time and Adherence to Safe Sleep Practices Among Mothers of Very Preterm Infants

BACKGROUND

Sleep-associated infant death is the leading cause of postneonatal mortality in the United States. Preterm infants are at higher risk for sleep-associated death, but maternal adherence to safe sleep practices is lower than for mothers of full-term infants. Data are lacking on whether maternal neonatal intensive care unit (NICU) visitation time impacts safe sleep compliance after hospital discharge.

PURPOSE

For mothers of preterm infants, to investigate the association of time days per week spent in the NICU and adherence to safe sleep practices after discharge.

METHODS

A prospective observational study of 109 mothers with infants born at less than 32 weeks from 4 Colorado NICUs who completed a survey at 6 weeks after discharge about infant sleep practices. Maternal time spent in the NICU was defined as the average number of days spent in the NICU per week of infant hospitalization, as documented in the electronic medical record. Multivariable logistic regression models assessed the relationship between time in the NICU and safe sleep adherence. Covariates included maternal/infant characteristics significant at P < .2 level in bivariate analysis.

RESULTS

Predictors of compliance with all safe infant sleep practices included public/no insurance compared with private insurance (adjusted odds ratio [AOR] 0.29; 95% confidence interval [CI] 0.09-0.96), some college/associate-level education versus bachelor's degree (AOR 5.88; 95% CI 1.21-28.67), and depression/anxiety symptoms (AOR 0.37; 95% CI 0.14-0.97). NICU visitation days was not associated with adherence to safe sleep practices.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Maternal visitation days was not associated with adherence to safe infant sleep practices after discharge, highlighting the need to identify barriers and facilitators to engaging families about SUID risk-reducing behaviors.

Addressing caregiver mental health in the neonatal ICU

PURPOSE OF REVIEW

The neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals.

RECENT FINDINGS

Parents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes.

SUMMARY

To properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU.

VIDEO ABSTRACT

http://links.lww.com/MOP/A70.

National Cross-Sectional Study of Mental Health Screening Practices for Primary Caregivers of NICU Infants

Universal screening for postpartum mood and anxiety disorders (PMADs) has been recommended for all new parents at outpatient postpartum and well-child visits. However, parents of newborns admitted to the NICU are rarely able to access these services during their infant’s prolonged hospitalization. The objective of this study was to determine the prevalence of mental health screening and treatment programs for parents or other primary caregivers in NICUs across the country. In this cross-sectional study, US NICU medical directors were invited to complete an online survey about current practices in mental health education, screening, and treatment for primary caregivers of preterm and ill infants in the NICU. Comparative analyses using Fisher’s exact test were performed to evaluate differences in practices among various NICU practice settings. Survey responses were obtained from 75 out of 700 potential sites (10.7%). Of participating NICUs, less than half routinely provided caregivers with psychoeducation about mental health self-care (n = 35, 47%) or routinely screened caregivers for PPD or other mental health disorders (n = 33, 44%). Nearly one-quarter of the NICUs did not provide any PMAD screening (n = 17, 23%). Despite consensus that postpartum psychosocial care is essential, routine mental health care of primary caregivers in the NICU remains inadequate.

Postpartum Depression Screening for Mothers of Babies in the Neonatal Intensive Care Unit

BACKGROUND

Postpartum depression (PPD) is a prevalent, yet underidentified, problem among mothers with babies in the Neonatal Intensive Care Unit (NICU). Postpartum depression can result in immediate and long-term consequences for mother and baby. Screening, followed by early intervention, is critical for improvement and resolution. The purpose of the project was to initiate early screening for PPD among a high-risk population to identify and refer for early treatment.

METHODS

A screening and referral protocol was implemented using the Edinburgh Postnatal Depression Scale (EPDS), with consults as indicated to an onsite licensed professional clinical counselor. The nurse on the care team was responsible for initiating the screening after 2 weeks postpartum and placing a mental health referral as needed. Retrospective medical record reviews were conducted to determine whether timely screening was implemented among eligible mothers, and if referrals were made for those at-risk based on EPDS score.

RESULTS

Twenty-four percent of women screened were at increased risk for PPD based on their EPDS score, approximately double that of the general population (12.5%). All women with a positive screen had a referral placed and were seen by the licensed professional clinical counselor within 3 days.

CLINICAL IMPLICATIONS

This project recognizes the importance of an interdisciplinary care approach and highlights the need for early identification and treatment for PPD among mothers with babies in the NICU. The project can guide future initiatives to increase the use of screening in the inpatient setting, to detect PPD during its early and more treatable stages.

Feasibility of universal screening for postpartum mood and anxiety disorders among caregivers of infants hospitalized in NICUs: a systematic review

This systematic review evaluated the feasibility of implementing universal screening programs for postpartum mood and anxiety disorder (PMAD) among caregivers of infants hospitalized in the neonatal intensive care unit (NICU). Four moderate quality post-implementation cohort studies satisfied inclusion criteria (n = 2752 total participants). All studies included mothers; one study included fathers or partners. Screening included measures of depression and post-traumatic stress. Screening rates ranged from 48.5% to 96.2%. The incidence of depression in mothers ranged from 18% to 43.3% and was 9.5% in fathers. Common facilitators included engaging multidisciplinary staff in program development and implementation, partnering with program champions, and incorporating screening into routine clinical practice. Referral to mental health treatment was the most significant barrier. This systematic review suggests that universal PMAD screening in NICUs may be feasible. Further research comparing a wider range of PMAD screening tools and protocols is critical to address these prevalent conditions with significant consequences for parents and infants.

Maternal postpartum depression: risk factors, impacts, and interventions for the NICU and beyond

PURPOSE OF REVIEW

Postpartum depression (PPD) negatively impacts caregivers, infants, siblings, and entire families. Mothers with infants admitted to the neonatal intensive care unit (NICU) face additional risk for PPD, coupled with risk factors extending beyond a NICU admision. The novelty of this review is the focus on maternal PPD for mothers with infants admitted to the NICU. Interventions aimed at limiting and preventing PPD in this population include: prenatal and postpartum depression screening, PPD symptom awareness and monitoring, and trauma-informed care.

RECENT FINDINGS

PPD, the most frequent complication of childbirth, affects approximately 10-15% of mothers worldwide. Prevalence rates increase to 40% for mothers whose infant is admitted to the NICU. PPD can affect maternal and child health across the life course and predispose future generations to a myriad of developmental, psychosocial, and physical challenges. Prevalence rates are higher for racial and ethnic minorities, immigrant and refugee populations, and mothers in rural locations. Trauma-informed care is suggested at individual and organizational levels, leading to better care for those with and without previous trauma exposure.

SUMMARY

Increasing PPD symptom awareness, screening for PPD, and connections with resources should begin during prenatal visits. Care teams should discuss barriers to resources for mothers, children, and families to improve access and support.