790 - Prevalence of anxiety/depression in pregnancy and post-partum: a matter of population or documentation?

Poster Number: 790
Publication Number: 790.249

Denisse V. Moncada, Beth Israel Deaconess Medical Center, Jamaica Plain, MA, United States; Marianna B. Castellanos, Beth Israel Deaconess Medical Center, Boston, MA, United States; Kelly Walter, Beth Israel Deaconess Medical Center, Boston, MA, United States; Rachel L. Hansen, Beth Isreal Deaconess Medical Center, Boston, MA, United States; Saumya Vodapally, Harvard Medical School, Boston, MA, United States; Isabella Lawandy, Brigham and Women's Hospital, Boston, MA, United States; Chloe Andrews, Brigham & Women's Hospital, Boston, MA, United States; Genevieve Guyol, Boston Children's Hospital, Cambridge, MA, United States; Sarbattama Sen, Brigham and Women’s Hospital, Boston, MA, United States; Camilia Martin, Weill Cornell Medicine, NY, NY, United States; Asimenia Angelidou, Harvard Medical School, Boston, MA, United States

Background: One in 5 women are diagnosed with anxiety and 1 in 7 with depression during pregnancy, placing them at high risk for post-partum depression. Accurate reporting in the medical record of past and active anxiety/depression (a/d) is essential for identification of high-risk women who may benefit from early interventions and close monitoring. 

Objective: Our objective was to determine factors that may influence screening for or documentation of a/d diagnoses by healthcare providers. We hypothesize that certain demographic/clinical variables may affect provider documentation of these diagnoses.

Design/Methods: Within a prospective longitudinal study of lactation outcomes among mothers of healthy term infants who delivered at two Boston-based hospitals between 2019-2022, we tracked screening/documentation of current a/d.  We initially focused on physician admission notes and the problem list, then expanded data extraction to include information from past medical history sections, prenatal care notes, obstetrical care notes, nursing admission documentation, discharge notes, and medication lists.

Results: Based on the initial, focused data extraction, rates of current a/d documentation were 48.0% and 20.4% for sites 1 and 2, respectively.  The large differences between the two sites prompted us to expand our data extraction strategy and use at least two sources of information corroborating current diagnoses of a/d to minimize their over- or under-representation. Based on expanded data extraction, a/d documentation rates were 42.0% for site 1 and 28.8% for site 2; however, only 16% and 17% of prenatal care notes, respectively, documented screening using the Edinburgh Postnatal Depression Scale. The top 3 places documenting a/d were the active problem list (86%), maternal conditions list (90%) and prenatal care notes (60%). There were significantly more mothers with history of infertility (p=0.045), and delivered by cesarean (p=0.018) in site 1 vs 2 (Table 1), which may partially explain site differences in a/d rates. However, when sites 1 and 2 were analyzed together, we identified no significant differences between mothers with and without active a/d diagnoses, suggesting that rate differences were primarily the result of provider-driven variation in screening and documentation practices.

Conclusion(s): Diagnoses of a/d during pregnancy and post-partum are not consistently screened for or documented by providers in the medical record, which may hinder prompt evaluation, treatment, and follow-up after hospital discharge to promote maternal well-being.