Oral Papers: Women's Mental Health & Pediatrics
Tiffany Moore Simas, MD, MPH, MEd, FACOG
Professor of Obstetrics & Gynecology, Pediatrics, Psychiatry and Population & Quantitative Health Sciences
UMass Medical School/UMass Memorial Health Care
Objective: Perinatal depression is the most common pregnancy complication and universal screening is recommended (Deave, 2008; Grote, 2010; Kendig, 2017; Siu, 2016). The Practice Readiness to Evaluate and address Perinatal Depression (PREPD) assessment was developed to evaluate an obstetric practice’s readiness for behavioral health intervention implementation. Objectives are to: (1) describe the PREPD; (2) evaluate assessment validity; and, (3) describe associated practice, provider, and patient characteristics by readiness level.
Methods: The PREPD was developed pairing subject-matter expertise with published literature. PREPD evaluates four components, each scored to a 16-point maximum: (1) Environmental Scan (10% of PREPD); (2) Depression Detection, Assessment, and Treatment Questionnaire (30%); (3) Depression-related Policies Questionnaire (10%); and (4) Chart Abstraction (50%). Chart Abstraction included six sub-components (Depression detection, Assessment, Treatment, Follow-up, Care transfer, and Bipolar detection). Each of the 4 main components is weighted by their PREPD proportion and summed to create an overall score. Summary and component scores were calculated by patient, practice, and provider. Preliminary PREPD validity testing was conducted.
Results: Average overall PREPD score was 7.3, ranging 4.8-9.9. Wide ranges existed in PREPD scores between practices, the four individual components, and sub-components. The Environmental Scan averaged 2.0 (range 0-5.2); Detection, Assessment, and Treatment averaged 8.3 (range 3.0-11.5); Chart Abstraction averaged 7.2 (range (5.1-9.6); and, Depression-related Policies averaged 10.4 (range 7.5-15).
Discussion: These data suggest wide baseline variation in readiness for implementing behavioral health interventions; most practices were minimally prepared. The PREPD quantifies the extent to which individual obstetric practices are ready to implement interventions for perinatal depression and provides a method to monitor changes over time with clear benchmarks to help guide practices in better integrating depression care into their workflow.
Implications: The Practice Readiness to Evaluate and address Perinatal Depression (PREPD) assessment was developed to evaluate obstetric practices’ readiness to implement depression screening, assessment, treatment, and follow-up. It may be a valuable tool to help obstetric practices tailor their care processes to most successfully address perinatal depression among their patients.
Deave T, Heron J, Evans J, et al.: The impact of maternal depression in pregnancy on early child development. BJOG 2008; 115:1043-51.
Grote NK, Bridge JA, Gavin AR, et al.: A Meta-analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction. Arch Gen Psychiatry 2010; 67:1012-24.
Kendig S, Keats JP, Hoffman C, et al.: Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety. J Midwifery Womens Health 2017;62:232–239.
Siu AL, Force USPST, Bibbins-Domingo K, et al.: Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 315:380-7.