Postpartum behavioral health screening and engagement among a predominantly Hispanic, Spanish‐speaking underserved population

Abstract

Objective
Behavioral health (BH) screening during the postpartum period is recommended, but screening frequency remains unclear, particularly in underserved populations, where screening is often limited to a single 6‐week postpartum visit. This study evaluated the acceptability of different screening schedules and tracked the time to disengagement from postpartum BH screening in a predominantly Hispanic, Spanish‐speaking, publicly insured group.


Methods
This prospective cohort study enrolled 181 postpartum patients at delivery into three screening protocols to assess depression, anxiety, and posttraumatic stress symptoms. Patients planning to return to work within 6 months were assigned to the intensive protocol (16 touchpoints over 36 weeks). Others, including unemployed patients and those returning after 6 months, were randomized to the moderate‐ (8 touchpoints) or high‐frequency (10 touchpoints) protocol over 24 weeks. Primary outcomes included compliance (completed assessments), complete adherence (all assessments), attrition (missing ≥3 visits), and time to disengagement (first missed visit). Secondary outcomes included participant satisfaction at 12 months. Group differences were explored using nonparametric and categorical tests with Bonferroni adjustments. Time to disengagement was examined with Kaplan–Meier curves and Cox models.


Results

Participants were primarily Hispanic (93%), Spanish‐speaking (76%), and publicly insured (82%). Compliance was highest in the moderate group (85%), followed by the high‐frequency group (84.8%) and the intensive group (71%). Attrition rates were low across all groups, ranging from 10.0% to 15.6%. In exploratory survival analyses, participants assigned to the intensive protocol demonstrated earlier disengagement compared with those in the Moderate and High frequency schedules (HR = 2.1;
p
 = 0.006). Notably, among participants who screened positive for depression, anxiety, or posttraumatic stress symptoms, 64% were first identified after the standard 6‐week postpartum visit, a pattern consistent across screening protocols. Participant satisfaction remained high across all groups.



Conclusion
Extended, multipoint screening for BH symptoms is feasible and highly acceptable in underserved Hispanic populations where retention is challenging. Ongoing screening is vital for detecting unnoticed BH issues and facilitating timely care. This study demonstrates that focusing on screening frequency rather than uptake and adopting flexible, culturally responsive methods can increase postpartum BH engagement.