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Most moms with PPD identified by pediatricians don’t receive mental health care



Fewer than 10% of women who screened positive for postpartum depression (PPD) in a pediatric setting received mental health services in the following 6 months, according to results of a retrospective study that used linked data from children’s EHRs and maternal Medicaid claims.

“My big takeaway from all of this is, if as pediatricians we’re committed to screening for postpartum depression, which we are – it’s in our Bright Futures guidelines – then we also need to focus on that next step and make sure that the mothers we find actually get services,” Stacey Kallem, MD, a pediatrician at Children’s Hospital of Philadelphia, reported at the Pediatric Academic Societies meeting.

Woman with distressed expression holding a baby monkeybusinessimages/Thinkstock
Screening for postpartum depression is an evidence-based practice that is universally recommended. While generally this would be done by an adult care provider, a recent study of women with Medicaid insurance and uncomplicated pregnancies found that 40% do not attend postpartum obstetrics visits in the 3 months post delivery and 50% don’t see their primary care doctors in the year after delivery.

“Most moms are still bringing their children to see us, the pediatricians, so we’re really a touch-point to the health care system for a lot of mothers, which is why over the last decade or so there has been a big shift within pediatrics to screen mothers for postpartum depression,” said Dr. Kallem.

Because of the growing prevalence of PPD – one in seven women will suffer from it – and mindful of its negative effects on infant health, safety, and development, the American Academy of Pediatrics recommends that pediatricians screen mothers when they bring children for visits. However, what is unknown is the effectiveness of this screening and if the affected mothers ultimately are getting mental health services.

Dr. Kallem and her colleagues designed a retrospective cohort study that would include mothers attending their infants’ 2-month well child visits at one of five academic urban primary care practices between 2011 and 2014. The obtained data came from linking the child’s EHRs and birth certificate records to maternal Medicaid claims.

The primary outcome was mental health care utilization within 6 months of screening positive for PPD on the Edinburgh Postnatal Depression Scale. A total of 3,052 mothers met study criteria, of whom 1,986 (65.1%) completed the PPD screen, and 263 (13.2%) screened positive for PPD. Only 9.9% of women had one Medicaid claim for depression in the 6 months after screening positive and 4.2% had two or more visits.

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