Healthcare Providers and Maternal Depression: The Need for Screening
October 26, 2018
The recent HealthStream Webinar, “Maternal Mental Health Risk Assessment and Intervention Before, During, and After Pregnancy,” featured Susan Kendig, an attorney and nurse practitioner with more than 35 years of experience in the healthcare industry. This blog post continues our series based on this webinar that will focus on maternal mental health.
The CDC estimates that almost 20 percent of women will experience some type of depressive episode during or after pregnancy. Untreated, this can have a devastating effect on women, their innocence, and their families. Maternal suicide within a year of birth is emerging as a significant cause of maternal mortality, and it's probably under-reported in the United States. States are now undertaking, looking at maternal mortality reviews and incorporating review of suicidality during pregnancy or that first year postpartum. Both in Colorado and Illinois, they have found that suicides are actually, when you look at maternal deaths both during pregnancy and that first year postpartum, from suicide or drug overdose, they seem to be outpacing the medical conditions combined and are emerging as one of the top causes of maternal mortality. Certainly, something to consider in terms of prevention strategies and recognition strategies.
Generally, depression with perinatal part of mindset is defined as occurring during pregnancy or within four weeks postpartum whereas major and minor depressive episodes occur during pregnancy or in the first 12 months postpartum are also looked at in these statistics. There are significant implications. Women who are having issues in terms of depression and anxiety may not adhere to their prescribed medical regimens.
High-risk Patients and Mental Health Conditions
Think about your high-risk patients in terms of those women who have severe hypertensive disorders, diabetes and pregnancy and so forth. Having an overlay of mental health conditions may actually contribute to less than optimal outcomes. Certainly, there are issues with the newborn, not the least of which would be a potential for failure to thrive, increased risk of pediatric issues and at the very least missing those really important pediatric appointments and immunization.
Anxiety should also be considered during the prenatal and postpartum period because actually the prenatal and postpartum prevalence, particularly, when you look at the full spectrum of anxiety disorders, equals or surpasses that of depression during pregnancy and prenatal anxiety is really a very strong predictor of perinatal depression as well. Outcomes tend to be similar.
Recommended Maternal Screenings for Depression
The American Academy of Paediatrics was actually the first to come on board with this, recommending that pediatricians screen mothers for depressive symptoms at child visits at one, two, and four months. They have since updated that recommendation to continue those during that first year. The important thing to remember if your pediatricians are implementing this protocol, there needs to be some type of feedback loop back to the women's health care provider as well as her primary care provider. Because if the woman is screened in that pediatric encounter, the theory here is many women will attend the newborn visits. However, about 40% of women across the board miss their postpartum visits. So, having pediatricians screen is an excellent idea. The next step would be having that feedback loop because if she does come to her women's health care provider or her primary care provider for a variety of reasons and they don't know that she has had a screen that indicates risks, there again maybe a missed opportunity.
In May 2015, ACOG published a committee opinion, the American College of Obstetricians and Gynecologists, to screen at least once during the prenatal period and the US Preventive Services Task Force followed that with a statement including depression screening for pregnant women both in the antepartum and postpartum period.
To learn about training solutions that prepare providers to address this serious issue, access the full webinar recording here.