A Participatory Approach to Enhance Screening System for Perinatal Mood and Anxiety Disorder in Critical Care Settings

Perinatal mood and anxiety disorders are common obstetric complications. Caregivers of infants in neonatal intensive care units and those visiting paediatric emergency departments experience a significantly higher risk of these disorders, with up to 45% screening positive for depressive symptoms in the neonatal intensive care unit and 27% in the paediatric emergency department. However, current screening and treatment systems in both settings are insufficient, with only a fraction of caregivers being screened. This study seeks to identify the drivers and barriers to effective screening for perinatal mood and anxiety disorders in both the neonatal intensive care unit and paediatric emergency department using a systems thinking approach called group model building. By engaging participants in mapping the factors influencing the screening system at the Children's National Hospital, this study identifies key mechanisms, including barriers and drivers, that affect screening performance. One barrier to increasing screening is the identification of positive cases, which demand staff attention and limit their ability to approach new caregivers. High staff turnover, driven by stress, low pay and the repetitive nature of the work, further limits the system's screening capacity. On the other hand, several factors can drive improvements in screening performance. A critical driver for enhancing screening is highlighting the prevalence of post‐partum depression among caregivers and securing financial resources to support a dedicated team. This allows for greater diagnosis of affected caregivers and ensures sustainability and expansion of the programme. While efforts to reduce mental health stigma are slow to take effect, they can significantly improve screening rates over time. Additionally, optimizing waiting times in the paediatric emergency department can increase screening opportunities. The insights from this study may help improve existing screening programmes and guide other hospitals in initiating and sustaining similar efforts, ultimately benefiting both caregiver mental health and infant health outcomes in the neonatal intensive care unit and paediatric emergency department.