Abstract: A PATH to Services: Acceptability, Feasibility, and Preliminary Effectiveness of a NICU Discharge Parent Mental Health Program (Society for Social Work and Research 31st Annual Conference)

Schedule:

Sunday, January 24, 2027

Golden Gate 8 (Hilton San Francisco Union Square)

* noted as presenting author

Susanne Klawetter, PhD, Associate Professor, University of Colorado, Aurora, CO

Sunah Hwang, MD, PhD, MPH/MSPH, Assistant Professor, University of Colorado, Aurora, CO

Christina Nicolaidis, MD, MPH, Professor, Portland State University

Allison Dempsey, PhD, Professor, University of Colorado, Aurora, CO

Cindy McEvoy, MD, MCR, Neonatologist, Oregon Health Sciences University

Dmitry Dukhovny, MD, MPH, Professor, Oregon Health Sciences University, OR

Melinda Davis, PhD, MCR, Professor, Oregon Health Sciences University, OR

Susan Mikulich-Gilbertson, PhD, Professor, University of Colorado, CO

Background and Purpose:

Approximately 10% of US infants require neonatal intensive care unit (NICU) hospitalization, an experience associated with high risk for perinatal mood, anxiety, and trauma symptoms (PMATs) among parents. Perinatal depression affects up to 45% of NICU parents, with similarly high rates of perinatal anxiety (40-85%) and posttraumatic stress (50%). Untreated perinatal mental illness is associated with maternal mortality and morbidities, suboptimal child health and development, and significant economic costs. PMATs continue to affect parents after NICU discharge as they encounter heightened stress, caregiving demands, loss of care teams, and an abrupt drop in access to care.

Evidence-based interventions (EBIs) exist to treat PMATs, with stepped-care and telehealth delivery approaches shown to improve mental health services uptake and reduce symptoms. Despite demonstrated need and EBIs, NICUs lack systematic protocols for identifying PMATs and connecting parents to care through discharge. In response, we developed the PArent mental healTH program (PATH) in partnership with NICU parents and staff. PATH provides screening and stepped-care engagement in brief behavioral telehealth or outpatient care based on PMATs risk level. This proposal describes acceptability, feasibility, and preliminary effectiveness results from a pilot trial of PATH.

Methods:

We conducted a pilot randomized controlled trial at two NICUs in the Western US. Participants included parents of infants admitted to either NICU for at least 2 weeks and were randomized to treatment as usual (TAU) or intervention (PATH) stratified by site. Participants completed surveys via secure email link at discharge (T1), 2-weeks post-discharge (T2), and 6-weeks post-discharge (T3). Surveys included validated screeners of perinatal depression, anxiety, and posttraumatic stress, as well as measures of mental health self-efficacy and mental health stigma. PMATs risk level was identified; PATH participants at level 2 (low-moderate) received brief behavioral telehealth and those in level 3 (moderate-severe) were referred to outpatient care. We conducted descriptive analyses to assess randomization and protocol engagement, as well as preliminary evaluation of raw data for key outcomes.

Results:

Across sites, 31 participants were randomized to PATH and 32 to TAU. Descriptive analyses show similar distributions of characteristics in PATH and TAU for demographic categories such as race, ethnicity, health insurance, education, marital/partner status, and household income. Within PATH, 42% qualified for actionable risk compared to 45% in TAU qualifying at T1. Only 3 additional participants moved into actionable risk at T2 or T3, i.e. T1 screeners identified most parents who indicated PMATs risk at any time point. There was strong protocol engagement with 95% completing surveys at T2 and 84% at T3. Preliminary evaluation of raw data suggests improvement in measures of mental health stigma, depression, and posttraumatic stress.

Conclusions:

Results support the acceptability and feasibility of the study protocol. Randomization successfully balanced groups and most participants stayed engaged in the study through all three time points. Results suggest that PMATs screening at NICU discharge may effectively identify most parents at risk for developing PMATs. Preliminary evaluation suggests PATH may reduce symptoms of perinatal depression and posttraumatic stress, as well as perinatal mental health stigma.