Making a Difference: Pediatricians and Maternal Peripartum Depression
LydiaFurman, MD, Associate Editor, Pediatrics
In a recently released issue of Pediatrics, both an AAP Policy Statement (10.1542/peds.2018-3259)and an AAP Technical Report (10.1542/peds.2018-3260) address “Incorporating Recognition and Management of Perinatal Depression into Pediatric
Practice.” Both documents are comprehensive and summarize key information for pediatricians
about perinatal depression. The term “perinatal depression” is now preferred to “postpartum
depression” due to the likely onset of depression during pregnancy and prior to delivery.
Did you realize that perinatal depression is both the most prevalent (15-20% prevalence)
and the most underdiagnosed and undertreated obstetrical complication? It is estimated
that 50% of women who are perinatally depressed are neither diagnosed nor treated,
yet we know that maternal depression has profound negative impacts on the short term
and long term health of mothers and children, and on the entire family unit. Increasing
evidence reveals that fathers, too, experience perinatal depression, and that the
father’s affect also directly impacts the child’s mental health and wellbeing.1 These long and strong articles review multiple aspects of perinatal depression, including
use of screening tools for identification of at-risk parents, referral and treatment
plans and obligations, and the sequallae of lack of treatment.
Screening for perinatal depression has been advocated for nearly a decade, but only
relatively recently have formal professional recommendations from the American Academy
of Pediatrics, the American College of Obstetrics and Gynecology (ACOG) and the American
Academy of Family Practitioners (AAFP) endorsed screening.2-5 The Fourth Edition of Bright Futures (2017) recommends that pediatricians screen
for maternal perinatal depression at 4 well care visits in the first 6 months of life,
and the American College of Obstetrics and Gynecology (ACOG, 2015) now recommends
routine antenatal screening for depression.3,5 Billing is also finally aligned with practice and patient care needs since the Center
for Medicaid and Medicare Services agreed that pediatricians can bill for depression
screening of the child’s caregiver in 2016. The approved CPT code is 96161. It is
a huge relief for providers when time well spent is specifically reimbursed.
It is a fascinating paradox to me as a provider that screening requires adherence
to the very specific words and phrasing of the screening tool, yet also demands that
each of us be flexible and attentive for signs and symptoms of potential depression
in individual parents. A mother may provide stoic denials to specific screening questions
on validated tools, yet at the same visit may respond with clear endorsement of depressive
symptoms to indirect queries, such as, “Did you have depression with your other kids?”
or “Have you slept or eaten at all since the baby came home?” or “Do you think you
might have depression?” Mothers may be willing to endorse fatigue, anxiety and feelings
of being overwhelmed without realizing these may be depressive symptoms. So screen
each mother, and father too, for perinatal depression with approved and recommended
tools, but at the same time make sure your clinical antennae are always tuned, so
that you miss as few depressed parents as clinically possible. This one’s on us.
1. Freitas CJ, Williams-Reade J, Distelberg B, Fox CA, Lister Z Paternal depression
during pregnancy and postpartum: An international Delphi study. J Affect Disord. 2016 Sep 15;202:128-36.
2. Earls MF; Committee on Psychosocial Aspects of Child and Family Health, American
1244 Academy of Pediatrics. Clinical report: Incorporating recognition and management
of 1245 perinatal and postpartum depression into pediatric practice. Pediatrics. 1246
3. American College of Obstetricians and Gynecologists. Screening for perinatal 1251
depression. Committee Opinion No. 630. Obstet Gynecol. 2015;125(5):1268–1271
4. Lanagan RC and Goodbred AJ. Identification and Management of Peripartum Depression.
Am Fam Physician. 2016 May 15;93(10):852-858.
5. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision
1278 of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American
Academy 1279 of Pediatrics; 2017.