The American Academy of Pediatrics released an updated policy statement urging physicians to increase screening of women for perinatal depression. The statement titled “Incorporating Recognition and Management of Perinatal Depression into Pediatric Practice” was updated from an original statement in 2010.
Perinatal depression can affect women during pregnancy and up to one year after delivery. This includes the pregnancy (or antepartum) as well as the postpartum period. The CDC reports that 15-20% of women experience perinatal depression. Studies have shown that about 50% of women with perinatal depression go undiagnosed and untreated. It is one of the most common and costly obstetrical complications in the United States when under-recognized.
Some of the reasons for current low rates of perinatal screening include: ongoing stigma associated with mental health conditions, system level challenges when it comes to training providers and paying them to screen, and new parents’ hesitation to admit to emotional struggles when they are supposed to feel happy. New mothers worry about being judged as being inadequate.
There are several risk factors for the development of perinatal depression. These include: family and personal history of depression, substance abuse, marital discord, family violence, isolation, poverty, difficult infant temperament, young maternal age and chronic illness. Risk is also higher for teen mothers, mothers with multiple births and preterm births.
The risks associated with perinatal depression are many. During pregnancy, a woman might not seek adequate prenatal care and the baby is at risk to be born prematurely and with low birth weight. Once the baby is born, there can be feeding concerns and struggles with breastfeeding. Social emotional risks include trouble with maternal-infant bonding and poor attachment. Additionally, the mother can have a distorted perception of the infant’s behavior and impaired attention and judgment concerning safety. In the longer run, there could be negative effects on the infant’s brain development.
The AAP policy statement recommends that doctors screen women for perinatal depression once during pregnancy and again at the baby’s 1, 2, 4 and 6 month checkups. The Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale are useful screening tools. This involves involvement by ob-gyns as well as primary care physicians (pediatricians, family medicine doctors). New fathers are also vulnerable to depression in the postpartum period and it is important to screen and refer them as well to treatment if needed. It is important for providers to be able to refer patients who screen positively for ongoing assessment and resources for support and treatment.
The AAP updated policy statement comes as a good reminder that helping a mother’s wellbeing and emotional health helps the baby’s health. Screening for perinatal depression during doctor’s visits for the baby helps bridge the gap for those mothers with depression to get treatment and support. Families can be referred to SmartCare BHCS for specific linkage to resources.