Researchers developed and implemented an app to screen for social determinants of depression, substance use, and mental health in pregnancy, providing pregnant women with HIPAA-compliant intelligence at 2 Montefiore OB/GYN clinics Mobile application. The author of this article is Dr. Sarah Ricketts, Montefiore Nursing Management Organization, New York.
Depression during pregnancy or postpartum can have serious negative effects on the mother, fetus, child, and family. Depression screening in perinatal women is not routinely performed in many practice settings. Recognizing the value of smartphone apps in providing health and self-management information, researchers developed and implemented an app to screen for social determinants of depression, substance use, and mental health in pregnancy. The app includes a two-way chat feature to support user engagement.
The researchers provided pregnant women with HIPAA-compliant smartphone applications at two Montefiore OB/GYN clinics. Eligible women included women less than 28 weeks gestation who possessed an Android or iOS smartphone and were fluent in English or Spanish. Nursing supervisors and telephonic mental health nurses formed the research team to lead the project and work closely with obstetricians.
Eligible women are identified through a daily roster of obstetric appointments. Nurse supervisors contact patients in person at the clinic or by phone. Interested and consenting women were entered into the dashboard, and the researchers provided instructions for downloading and using the app. In addition to weekly informative articles, patient health questionnaires were sent twice during pregnancy and postpartum for each pregnant woman.
Women who screened positive for depression or substance use were referred by mental health clinicians for telephone evaluation, and investigators provided patients with information about their symptoms and described treatment options, including toll-free psychotherapy and referral to an outpatient clinic for treatment. If a patient chooses to receive treatment, a psychiatrist can perform an immediate evaluation. If a patient chooses not to receive treatment, clinicians register monthly by phone and send health questionnaires through the app.
Refer patients to the appropriate agency through the app's chat feature if they are stuck with housing, food, legal or violence issues
Of the registered patients, 77% have been using the app. Fifty-four percent completed screening for depression, and 10% had a positive screening result with a score of ≥10. The percentage of women who screened positive for depression was consistent with prospective studies. 46% completed substance abuse screening. Electronic screening also confirmed earlier findings that management through self-reporting increased positive screening rates.
The researchers initially thought that in-person registration would be the best way to facilitate registration, but were surprised to find that telephone registration was nearly as effective as meeting patients in person. These preliminary results suggest that the integration of an innovative smartphone application into obstetric practice could improve screening for depression in a susceptible population of pregnant women, and thus improve early identification and treatment of depression.