Screen Early and Screen Often

Maternal postpartum depression can have serious adverse effects on the mother and child relationship, resulting in an environment that can disrupt the infant’s development, according to a new report from the American Academy of Pediatrics (AAP), which states that “infants who live in a neglectful or depressed setting are likely to show delays in development and impaired social interaction.”

The report—“Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice”—which is published in Pediatrics, encourages providers working in the pediatric practices to screen mothers for postpartum depression, to use community resources for the treatment and referral of the depressed mother, and to provide support for the mother-child relationship.

According to the author of the piece, Marian F. Earls, MD, of the Committee on Psychosocial Aspects of Child and Family Health, estimated rates of depression among pregnant and postpartum women can range between 5% and 25%, with family history of depression, alcohol abuse, and a personal history of depression all increasing the risk of perinatal depression.

Prenatal visits offer “an excellent opportunity to establish a relationship with the parents, assess for risk of depression and supports, and initiate preventive strategies,” stated Earls, adding that postpartum depression can lead to increased medical costs, inappropriate medical care, discontinuation of breastfeeding and child abuse and neglect.

“Screening and surveillance for risk and protective factors are an integral part of routine care and the relationship with the child and family,” according to the report, which recommends that discussion of family support systems and other psychosocial factors such as poverty, parental mental health, and substance use begin as early as the prenatal visit. The AAP also recommends that pediatricians communicate with obstetricians to inform them of their prenatal visit policies so that obstetricians might refer patients for the prenatal visit.

In terms of screening, the methods endorsed by the US Preventative Services Task Force are the Edinburgh Postnatal Depression Scale—which should be integrated at the 1-, 2-, 4-, and 6-month visits—along with the general 2-question screen for depression that the American College of Obstetricians and Gynecologists recommends should be utilized at least once per trimester (or 3 times during prenatal care).

The 2-question screen for depression is:

• Over the past 2 weeks, have you ever felt down, depressed, or hopeless?
• Have you felt little interest or pleasure in doing things?

The models and resources recommended by the AAP are as follows:

• Virginia Bright Futures training website, which has developed a new parent kit that includes information on perinatal depression and is given to 70% of new parents
• Parental Depression Screening for Pediatric Clinicians: An Implementation Manual, by Ardis Olson, MD
• Depression During and After Pregnancy: A Resource for Women, Their Families, and Friends
• Project Thrive, from the National Center for Children in Poverty
• Bright Futures
• The National Women’s Health Information Center, a federal government source for women’s health information.

For more:

• Pediatrics—Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice
• Critical Care Nursing Quarterly—Best practice guidelines for the nurse practitioner regarding screening, prevention, and management of postpartum depression
• From HCPLive: Pre/Postpartum Depression in Men

Do you screen for postpartum depression in your practice? What resources do you utilize for the treatment and referral of the depressed mother?