Addressing Mental Health: An Observational Study of Patient–Clinician Communication in the First Prenatal Visit [ID 1255]

INTRODUCTION: The American College of Obstetricians and Gynecologists recommends screening for perinatal depression and anxiety at the initial prenatal visit, later pregnancy, and postpartum. Despite these recommendations, few studies have empirically examined how these conversations are occurring. This study aims to analyze how provider type, race, prior drug use, and the Edinburgh Postnatal Depression Scale (EPDS) score influence provider–patient conversations about mental health. METHODS: We analyzed 164 transcripts of audio-recorded prenatal visits to identify and code discussions about mental health. A medical record review was performed for documented mental health history and EPDS use. Two researchers independently coded each transcript for mental health mentions. RESULTS: Mental health history was discussed by 38.4% of providers, with nurse practitioners initiating most of the discussions (75%), followed by nurse-midwives (70.5%), and physicians/residents being the least (22.6%). Only 6.7% of providers discussed postpartum depression (PPD) or depression in pregnancy (DIP). Among patients with EPDS scores of 9 or higher, 37.5% were asked about mental health. African American patients were more likely to be asked about mental health (41.9%) compared to Caucasian patients (29.8%). Among patients with a history of substance abuse, 38.1% were asked about mental health, and 7.1% discussed PPD/PID. CONCLUSIONS/IMPLICATIONS: Mental health screening is inconsistently occurring in first prenatal visits representing a missed opportunity to mitigate risks for negative postpartum outcomes. Addressing gaps in current screening practices, fostering stronger patient–provider relationships, and providing greater mental health resources can significantly enhance mental health discussions during prenatal visits.