MOVED TO POSTER SESSION III, 426A Integrated Mental Health Care in an Obstetrics Setting in Washington DC: A Mixed-Method Study

Introduction: Maternal mental health (MMH) problems affect between 10-20% of women, with higher rates among women of color. Despite the availability of effective screening tools, less than 50% of cases of perinatal anxiety and depression are recognized. While integrated MMH care exists in pediatric settings, there is no current model of integrated care in the obstetric setting in Washington, DC. The Early Childhood Innovation Network (ECIN) is evaluating the feasibility and acceptability of integrating a mental health advocate (MHA) into an obstetric clinic serving primarily high risk, low socio-economic (SES) patients. Low SES is the biggest risk factor for MMH disorders. However, the constellation of factors associated with low SES, including poverty, trauma, unintended pregnancy, single motherhood, and inadequate childcare, lead to increased stress, which in turn increases risk for MMH problems. The purpose of this study was to gather insight about patients’ needs to help guide the development of an integrated MH model in a high-risk OB setting.

Methods: A mixed-methods approach was used to gather patient information. Patients (N=133) completed a brief survey assessing beliefs about the impact of MMH needs and interactions with medical staff. Qualitative interviews were then conducted with a subset of patients (N=9) to gain further insight into their emotional experiences during pregnancy and postpartum, and to obtain patient recommendations for intervention. Quantitative data were analyzed using SPSS. Qualitative data were analyzed thematically through consensus procedures using Atlas.ti 6.

Results: Survey results indicate that most participants (73%, n=96) believe that their feelings, home life, and community affect their health. However, most patients reported that they would not like the medical team to ask about stressors (71.7%, n=71) or MH concerns (59.4%, n=57). These findings were confirmed in the patients’ interviews; patients felt that these issues were “too personal” to discuss with their provider. All women interviewed were open to participating in a group intervention. When asked about the preferred content of the group, responses varied, including childbirth, stress management, and parenting. Patients completed MMH screeners prior to the interview. While few patients scored in the clinically significant range for depression or anxiety (n=2), the MHA observed high stress levels, limited coping skills, and incongruent affect during the interviews.

Conclusion: The results demonstrate the interest and need for integrating mental health support within an urban high-risk OB clinic. Findings will be used by the research team to tailor and design the intervention.