Pathways to Perinatal Mental Health Equity

Change in perinatal individual depression symptoms as measured by Edinburg Postnatal Depression Scale (EPDS) or Patient Health Questionnaire (PHQ9)

Perinatal individual depressive symptoms will be determined from their medical charts, through the screening questionnaire used by their care setting. The screener may be the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire-9 (PHQ-9). The 10-item EPDS is the most widely used measure of perinatal depression symptoms. The 9-item PHQ-9 is the most widely-used measure of depression symptoms across the lifespan and the second most widely used measure during the perinatal period.

Change in perinatal individual anxiety symptoms as measured by Generalized Anxiety Disorder Scale (GAD-7)

Perinatal individual anxiety symptoms will be determined from their medical charts, through results of the Generalized Anxiety Disorder Scale (GAD-7). The GAD-7 has seven items assessing anxiety severity and is validated in perinatal populations.

Proportion of perinatal individuals with evidence of initiation of treatment/support in their medical chart

Perinatal individual initiation of treatment/support will be determined by their medical charts' indication that they have received treatment or support. Treatment or support is defined as one initial mental health assessment or treatment visit, peer support encounter, or currently on medication for depression or anxiety. Perinatal individuals will receive a score of 1 if they initiated treatment or support or a score of 0 if they did not initiate treatment or support. This outcome refers to the percentage of perinatal individuals who received treatment or support.

Perinatal individual screening, assessment, treatment, and follow-up

Whether perinatal individuals have received screening, assessment, treatment, and follow-up for mental health concerns will be determined from their medical charts. Receipt of screening and results (positive screen versus not) of screening will be determined from medical charts. Screeners will include Edinburgh Postpartum Depression Scale \[EPDS\], Nine-item Patient Health Questionnaire \[PHQ-9\], or Seven-item Generalized Anxiety Disorder scale \[GAD-7\]. Higher scores on these scales indicate higher symptom severity. Recognizing that a positive screen is not synonymous with a diagnosis, we will code mental health assessment (including administration and results of secondary screeners), as well as follow-up. Treatment follow-up will be defined as an average of ≥1 mental health service every month over 3 months or currently on medication for depression or anxiety during the study window.

Perinatal Individuals Social Determinants of Health (SDOH) screening and referral

Perinatal Individuals' Social Determinants of Health (SDOH) screening and referral will be determined by review of their medical charts. Researchers will look for completion of the steps in the WE CARE process (screening, discussion with care professionals, and referral for unmet needs) and responses to the 12-item WE CARE screener.

Workforce capacity and support for engaging in mental health care

Perinatal care setting staff and peer mentor capacity and support for engaging in mental health care will be measured by the Pathways survey. To develop the Pathways survey, we carefully reviewed questions and constructs from the Mini-Z Single-Item Burnout Scale, the Trauma-Informed System Change Instrument questionnaire, the Kaiser Family Foundation's National Survey of Physicians, and the Determinants of Implementation Behavior Questionnaire. Rather than focus on participants' behaviors (for which we will collect data from electronic medical records and PSI administrative databases), the survey emphasizes questions on participants' perspectives regarding motivation and capacity to deliver mental health care, beliefs about consequences, and trust. Higher scores on the Pathways survey indicate higher capacity and support for engaging in mental health care.