Perinatal Mood and Anxiety Disorder Screening in the Neonatal Intensive Care Unit: An Evidence-Based Maternal Mental Health Improvement Initiative

BACKGROUND: Mothers of infants admitted to the neonatal intensive care unit (NICU) are at a high risk of experiencing perinatal mood and anxiety disorders (PMAD). Undiagnosed PMAD contributes to negative psychosocial and health outcomes for mother and infant.

LOCAL PROBLEM: A process for screening NICU mothers for PMAD did not exist in this Tennessee NICU. The purpose of this evidence-based practice quality improvement (EBPQI) project was to initiate standardized PMAD screening for mothers with infants in the NICU. The aims of this project were to 1) screen 70% of mothers with an infant NICU length of stay (LOS) of 2 weeks or greater, 2) provide 70% of screened mothers with maternal mental health resources, and 3) refer 60% of mothers with positive PMAD screening for further assessment and management within 3 months of implementation.

METHODS: The Evidence-Based Practice Improvement Model guided the project’s planning and implementation using Plan-Do-Study-Act Cycles to refine and test the process.

INTERVENTIONS: Nurses administered PMAD screenings to NICU mothers at 2 weeks, 4 weeks, and 2 months based on a timed and automated task list. An algorithm determined actions based on the mothers’ PMAD screening scores. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen NICU mothers, producing an anxiety subscore and an overall depression score.

RESULTS: 43% of mothers with infants in the NICU with a LOS of 2 weeks or greater were screened for PMADs, and 14% were offered mental health resources at the time of the initial screening. 71% of screen-positive mothers were referred for further assessment, surpassing the aim of 60%.

CONCLUSIONS: Implementation of standardized PMAD screenings increased mental health screening for mothers with infants in the NICU. Recommendations were proposed to enhance the project's sustainability and improve screening and resource rates.