(C-120) Postpartum Depression and Comorbidities Among Women Participating in Smartphone-Delivered Digital Health Screenings

Background: Postpartum depression (PPD) affects up to 20% of women in the United States, in the year following pregnancy end, and can be influenced by the presence of comorbidities.

Objectives: To measure the prevalence of elevated PPD screens and examine the association between PPD and pre-existing comorbidities among women enrolled in a digital health intervention whose mental and physical health symptoms were tracked via a smartphone application (app).

Methods: A prospective cohort study included women who delivered a live-born infant at a large university health system from November 2021 through June 2024, were 18 years or older, spoke English, owned a smartphone, and were willing to respond to smartphone app-delivered assessments. Postpartum mental health was assessed in real-time using the Edinburgh Postpartum Depression Scale (EPDS), administered to all participants within the first 6 weeks of postpartum. Assessments were sent via the app once or more per week for 6 weeks following delivery discharge. Pre-existing comorbid conditions (anxiety, depression, hypertension), and baseline characteristics, were captured at enrollment from participants' health records in year 1 and self-report in year 2-3. Alerts were generated to the care team for EPDS scores>11 (indicating an elevated score) or non-responsiveness to 3 consecutive assessments, prompting nurse follow-up with an intervention, referral, or continued monitoring. The prevalence of elevated screens (EPDS score>11) was calculated for each week. Binary logistic regression was employed to examine associations between elevated EPDS scores and pre-existing comorbidities, controlling for sociodemographic factors in weeks 3-6.

Results: Of 2305 enrolled women, 136, 153, 639, 590, 588, and 509 participants completed the EPDS in weeks 1, 2, 3, 4, 5, and 6, respectively. Overall, the rate of elevated EPDS screens decreased over time. Among individuals who completed the surveys, the prevalence of elevated EPDS scores were 46.3% (week 1 [w1]), 37.9% (w2), 8.8% (w3), 7.0% (w4), 6.1% (w5), and 4.2% (w6). About 78% of participants ceased completion of EPDS by week 6. In weeks 3-6, women with anxiety and those who were unmarried had 2.09 (p=0.04) and 2.16 (p = 0.02) times higher odds of a positive EPDS screen. However, those with a history of depression and those who were black were 70% (p =0.01) and 56% (p=0.04) less likely to have a positive EPDS screen. No significant associations were found with other comorbidities (hypertension or preeclampsia) or sociodemographic factors.

Conclusions: Elevated EPDS screens were more common in women with a history of anxiety, emphasizing the need to closely monitor these patients for PPD earlier than the usual care practice of screening at 6 weeks.