P1.249: Who Declines Perinatal Mood and Anxiety Disorder Screening in the Neonatal Intensive Care Unit?

Purpose/Objectives: Parents in neonatal intensive care units (NICU) are at increased risk for perinatal mood and anxiety disorders (PMAD). Parents who have been socially or economically marginalized are at increased risk for adverse birth outcomes, PMAD, and experiencing barriers to accessing healthcare. The 2023 AAP Neonatal Standards of Care include depression screening; however, screening without attention to equity may exacerbate disparities. We implemented screening at 1, 2, 4, and 6 months and assessed demographics of parents declining screening to determine whether marginalized groups were disproportionately represented.

Design/Methods: A multidisciplinary team, including former NICU parents, developed a driver diagram and screening algorithm. PMAD-related educational materials were translated into Spanish, Somali, and Hmong, displayed in family spaces, and distributed with screens. Social work (SW) introduced screening via the Edinburgh Postnatal Depression Scale in parents’ preferred language, using translated screens when available. Screen results and demographics were collected from the electronic medical record from October 24, 2022-August 27, 2023. Notes were made if screening was not completed for a particular reason. Declined screens were defined as parents explicitly declining, returning blank screens, or declining SW involvement. Duplicates were removed if parents declined at multiple intervals. Analysis of eligible parents included only the 1-month screening interval to avoid duplicates. Parents identifying with more than one race/ethnicity were included as Multiracial except for those identifying as White and Hispanic.

Results: 131/190 (69%) of parents eligible for screening at 1 month completed screens, 52 (27%) did not complete screens but did not decline, and 7 (4%) declined. Of eligible parents at 1 month, 7 (4%) preferred Somali language, 75 (39%) had state insurance, 37 (19%) identified as Black, 16 (8%) as White/Choose not to answer and Hispanic/Latino, and 8 (4%) as Multiracial. 15 parents declined screening, including 9 (60%) who explicitly declined, 4 (27%) who returned blank screens, and 2 (13%) who declined SW involvement. Among parents declining screening, 2 (13%) preferred Somali language, 10 (67%) had state insurance, 6 (40%) identified as Black, 2 (13%) as White/Choose not to answer and Hispanic/Latino, and 4 (27%) as Multiracial. Multiracial parents who declined screening identified as Native American and Hispanic/Latino or Native Hawaiian or other Pacific Islander and White.

Conclusion/Discussion: Parents identifying as Black, Multiracial, or Hispanic as well as those with state insurance or Somali language preference were overrepresented amongst parents declining screening, suggesting perceptions of screening may be different across demographic groups. Limitations include small sample size and restriction of eligible parents analyzed to 1-month interval, which does not include parents of infants who were transferred to our NICU after 1 month. Focus groups and involvement of community partners may improve our understanding of why parents decline screening and inform modifications to facilitate equitable screening.