Maternal Depression Screening and Response

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Introduction

Maternal depression screening allows pediatricians and other health care providers to identify mothers who may be experiencing depression. Standardized maternal screening instruments such as the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire can help health care providers determine if a parent requires an evaluation for depression and treatment, or continued monitoring. A positive screen for maternal depression can also suggest the need for enhanced monitoring of the child’s social-emotional growth and other areas of development since maternal depression increases the child’s risk for social-emotional difficulties and developmental delays. When screening leads to a diagnosis of maternal depression, families may benefit from interventions that address parenting and child social-emotional well-being, including dyadic treatment and parenting programs.

State Profiles that Include Maternal Depression Screening and Response
Research Support for Maternal Depression Screening and Response

A large body of research shows that maternal depression harms children’s development. Maternal depression in parents of infants and young children can interfere with mothers’ responsiveness and positive parenting behavior that promote a secure parent-child relationship and optimal early child development. Young children of parents who experience depression in the early years are at risk of language delays and social-emotional problems, and maternal depression that persists can produce longer-term negative impacts on children’s development.1

Fortunately, effective treatments are available for maternal depression. These include supportive counseling, interpersonal psychotherapy, and cognitive behavioral therapy.2 However, because successful treatment of maternal depression is not always associated with improved parenting and child outcomes,3 additional interventions can be helpful. Dyadic treatment may be recommended for depressed mothers and their young child as an intervention that can improve the parent-child relationship and also reduce child behavior problems and parent stress (see Dyadic Treatment research summary). One group parenting program, Triple P, also has a version (Enhanced Triple P) for depressed mothers that has been found to improve parenting, reduce maternal depression, and improve child social-emotional and behavioral outcomes.4

In 2005 and 2006, New Jersey introduced an initiative to increase awareness of and treatment for postpartum maternal depression and also passed law requiring postpartum maternal depression screening. A study of this policy’s impact showed that rates of treatment initiation for postpartum depression did not change following these efforts. The study’s recommendations include payment to providers for screening and efforts to monitor screening.5 Other features of New Jersey’s policy that might have limited its impacts include inadequate training for providers and the absence of a requirement that providers follow a schedule of maternal depression screens in well child visits. Currently, many states use the American Academy of Pediatrician’s Bright Futures Medicaid EPSDT periodicity schedule which shows that four maternal depression screens should be conducted during well-child visits in the first year. 

A recent systematic review of research on maternal depression screening in well child visits showed that maternal depression screening in the first year postpartum can improve depression detection, referral, and treatment rates.6 Four studies examined in another review, including two with the strongest designs, found that screening reduced maternal depression symptoms.7 In these studies, parents received enhanced care, usually in the form of supportive counseling by a nurse.

Last updated October 2019

References
  1. National Forum on Early Childhood Program Evaluation, & National Scientific Council on the Developing Child. (2009). Maternal depression can undermine the development of young children (Working Paper 8). Cambridge, MA: Harvard University, Center on the Developing Child.
  2. O’Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379-407.
  3. Goodman, S. H., & Garber, J. (2017). Evidence-based interventions for depressed mothers and their young children. Child Development, 88(2), 368-377.
  4. Sanders, M. R., Kirby, J. N. Tellegen, C. L., & Day, J. J. (2014). The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 
  5. Kozhimannil, K. B., Adams, A. S., Soumerai, S. B., Busch, A. B., & Huskamp, H. A. (2011). New Jersey’s efforts to improve postpartum depression care did not change treatment patterns for women on Medicaid. Health Affairs, 30(2), 293-301.
  6. van der Zee-van den Berg, A. I., Boere-Boonekamp, M. M., IJzerman, M. J., Haasnoot-Smallegange, R. M., & Reijneveld, S. A. (2017). Screening for postpartum depression in well-baby care settings: A systematic review. Maternal and Child Health Journal, 21(1), 9-20.
  7. O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US Preventive Services Task Force. JAMA, 315(4), 388-406