85 Mental health service utilization and cost amongst parents post NICU discharge: A descriptive analysis

Abstract Background While mental health disorders are common in the postpartum period, the mental health of parents of infants in the neonatal intensive care unit (NICU) may be further compromised. Previous research demonstrates that up to 40% of NICU parents exhibit elevated levels of depression and anxiety, and endorse trauma symptoms shortly after their baby’s birth. Objectives To describe the parental and infant characteristics and costs associated with MHS use in parents of infants recently discharged from seven Canadian level III NICUs. Design/Methods The study was nested in an ongoing clinical trial of parents of high-risk infants across seven Canadian level III NICUs. Parent and infant characteristics were obtained at enrollment and summarized. Information pertaining to MHS use was obtained from the Resource Use Questionnaire administered to parents at 4 months post-enrollment (RUQ-4m). A pricing table allocating standard costs for services was created to estimate MHS costs for the services reported across the follow-up interval. Results A total of n=213 families completed the RUQ-4m. Of these, 33 individual parents (8%; n=25 female, n=8 male) across 28 families (13%) used MHS following infant discharge from the NICU. Therapy, including psychotherapy and social work, was the most utilized service (46%), followed by psychology (24%) and psychiatry (12%). Using the pricing table to estimate costs, an average of $541 per month was spent on MHS per family. Of these costs, 34% were paid directly by a government program, while 31% were paid at least in part out-of-pocket. Three-quarters (72%) of MHS users were born in Canada compared to 47% of non-users, 72% were on a leave from work compared to 59% of non-users, and 79% were first-time parents compared to 62% of non-users. The average length of hospital admission for infants of MHS users was 100 days compared to 143 days for non-MHS users. Finally, 20% of MHS users reported past or current depression compared to 8% of non-users. Conclusion We found that just over one-tenth of families used MHS post-discharge, that those who used MHS primarily used therapy, and that mental health services cost an estimated $540 per family per month. This is the first pan-Canadian study to describe MHS utilization and cost amongst parents post-NICU discharge. Given the high rates of mental health conditions in this population, the rates of MHS use reported were lower than expected. This preliminary data may represent those who were able to access care, rather than all participants who may have required MHS.

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