Feasibility and Acceptability of a Prevention-Focused Screener for Perinatal Depression Risk: Mixed Methods Cohort Study.

Background: More than 20% of perinatal women experience depression, with suicide being a leading cause of maternal death in the United States. Professional societies emphasize the need to identify those at risk of developing perinatal depression to better target preventive care delivery during pregnancy. Objective: We evaluated receptivity to a machine learning-based predictive screener designed to identify women in the first trimester of pregnancy who were asymptomatic but were at risk for developing moderate to severe depression symptoms later in pregnancy. Methods: Our participants were adult pregnant women with negative first-trimester depression (Patient Health Questionnaire-9) screens at 1 of 4 obstetric practices. Of the 810 women who were clinically eligible, 787 were successfully contacted via their patient portal. Of these, 289 (36.7%) viewed the screener and 255 (88.2%) completed the 6-question predictive screener. In total, 51 (20%) were identified by the screener as being at risk for developing perinatal depression. Participants were asked a series of follow-up questions regarding the acceptability of the predictive screener and desired preventive resources. Chi-square tests were used to compare demographic characteristics, perceived benefits and concerns, and desired resources between those identified as at risk for depression and those who were not. Differences in acceptability ratings between the two risk groups were determined using nonparametric Mann-Whitney U tests. Results: On a 5-point Likert scale of agreement, participants found the screener questions easy to complete (median score 5, IQR 5-5) and felt comfortable sharing their answers with their obstetric care providers (median 5, IQR 4-5). Key perceived benefits of completing the screener included opportunities to seek preventive care (75/255, 29.4%) and to receive education on depression risk (66/255, 25.9%). Primary concerns about knowing one's risk of future depression included worrying about developing depression (90/255, 35.3%) and a lack of prevention opportunities (39/255, 15.3%). Desired preventive resources included counseling (197/255, 77.3%), mind-body interventions (166/255, 65.1%) such as exercise, and prenatal classes or support groups (81/255, 31.8%). Conclusions: Participants found the screener acceptable and felt comfortable receiving it through their patient portal. Specific preventive care options were commonly endorsed, several of which are scalable and evidence based. A minority of participants voiced addressable concerns about knowing their risk of developing depression in the future.