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Recording available 2/16-5/2
Recording available 2/16-5/2
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Oral Concurrent Session 1 - Medical and Surgical Complications of Pregnancy

Oral Concurrent Sessions

Oral Concurrent Session 1 - Medical and Surgical Complications of Pregnancy

(17) Engagement Drives Detection: Rethinking Postpartum Behavioral Health Screening

Wednesday, February 11, 2026
3:00 PM - 3:15 PM  
Location: Summit 201 - 204

    Submitting Author and Presenting Author(s)

  • MA

    Miriam J. Alvarez, MA, PhD

    Research Scientist
    Department of Women’s Health, Dell Medical School at the University of Texas at Austin
    Austin, Texas, United States

    • Coauthor(s)

  • Anna Madden-Rusnak, PhD (she/her/hers)

    Research Scientist
    Department of Women’s Health, Dell Medical School at the University of Texas at Austin
    Austin, Texas, United States

  • CB

    Colby Brown

    Department of Women’s Health, Dell Medical School at the University of Texas at Austin
    Austin, Texas, United States

  • AG

    Alejandro Guevara, MPH

    Medical Student
    Texas Tech University Health Sciences Center Paul L. Foster School of Medicine
    El Paso, Texas, United States

  • VK

    Vaishnavi V. Kankate, MBBS, MS

    Research Associate
    Department of Women’s Health, Dell Medical School at the University of Texas at Austin
    Austin, Texas, United States

  • Lorie M. Harper, MD (she/her/hers)

    Associate Professor
    Department of Women’s Health, Dell Medical School at the University of Texas at Austin
    Austin, Texas, United States

  • Nandini Raghuraman, MD, MSCI (she/her/hers)

    Associate Professor
    Washington University School of Medicine
    Washington University School of Medicine, Missouri, United States

  • ER

    Erin Richardson, MSN, RN

    Psychiatric Nurse Practitioner
    Women’s Reproductive Mental Health, Dell Medical School at the University of Texas at Austin
    Austin, Texas, United States

  • JN

    Jeffrey Newport, MD, MS

    Professor
    Women's Reproductive Mental Health, Dell Medical School at the University of Texas at Austin
    Austin, Texas, United States

  • GM

    George A. Macones, MD, MS, MSCE

    Chair & Professor, Department of Women’s Health
    Department of Women’s Health, Dell Medical School at the University of Texas at Austin
    Austin, Texas, United States

  • Alison G. Cahill, MD, MSCI

    Assoc. Dean, Translational Research; Prof, Women’s Health; Dir, Health Transformation Research Inst.
    Department of Women’s Health, Dell Medical School at the University of Texas at Austin
    Department of Women’s Health, Dell Medical School at the University of Texas at Austin, Texas, United States

Objective:
Postpartum behavioral health (BH) symptoms disproportionately affect Hispanic and Spanish-speaking women, yet barriers to screening and engagement remain. This study evaluated predictors of BH symptom detection to inform care strategies for this underserved population.

Study Design:
In this prospective cohort study, 262 women were enrolled at delivery into one of four postpartum (PP) screening protocols (Table): Standard Care (baseline only), Moderate (baseline + every 4 weeks through 24 weeks PP), High (baseline + every 2–4 weeks through 24 weeks PP), or Intensive (biweekly through 36 weeks PP + two return-to-work screeners). Women returning to work within 6 months were assigned to Intensive; others were randomized. Primary outcomes included depression, anxiety, PTSD, and a composite BH outcome (positive on any). Engagement was defined by completion rate (≥85% = fully, < 85% = partially). Chi-square and Fisher’s exact tests were used for comparisons; logistic regression (excluding Standard Care) evaluated associations with group, engagement, return-to-work, and birth complications.

Results:
Of 262 women, 13% (n = 34) screened positive for at least one BH condition. Detection rates did not significantly differ by screening protocol (composite: 12%–16%, p = 0.91). Depression rates were similar across groups (9%–12%, p = 0.91), while anxiety and PTSD varied but were not significant (anxiety: 2%–9%, p = 0.35; PTSD: 0%–3%, p = 0.85). Regression showed no association between group, return-to-work, or birth complications and the composite BH outcome (p > 0.05). However, engagement was a strong predictor: partially engaged participants had significantly higher odds of screening positive (aOR = 6.9; 95% CI: 2.1–22.4; p = 0.01).

Conclusion:
Among Hispanic, Spanish-speaking PP women, screening engagement—not frequency—was the strongest predictor of BH symptom detection. These findings suggest that partially engaged women may represent a systematically higher-risk group. Identifying and developing strategies to reach those with inconsistent engagement is critical to improving BH outcomes in this population.