Health care delivery is generally complicated, but it doesn’t always have to be. Change can occur through a simple step. Take the case of maternal depression.
It is undisputed that depression is a highly treatable medical condition, especially if identified and treated early. It is also well-known that a mother’s depression negatively affects her ability to properly bond with and care for her child(ren). Like other forms of depression, maternal depression does not discriminate. It is widespread across socioeconomic groups and race, but research shows that poverty is a strong predictor, regardless of ethnicity. Depression interferes with work, sleep, appetite, and most importantly, a parent’s ability to parent his/her child. Maternal depression has been associated with fewer positive parenting behaviors and more negative interactions with their young children. Consequently, outcomes of children raised in a home with a depressed parent show a higher likelihood of developing behavioral problems and depression. It is also well-known that a mother’s depression negatively affects her ability to properly bond with and care for her child(ren).
Yet despite all that is known about maternal depression, women – especially low-income women – often do not get the treatment they need due to fear of discussing mental health concerns with their providers or a lack of education about depression. Several weeks ago, Beacon Health Options (Beacon) issued a white paper (http://beaconlens.com/integration/) on what the evidence shows as the best approach to behavioral and physical health care integration. In that paper, screening emerged as a critical tool. That same week, the U.S. Preventive Services Task Force (http://jama.jamanetwork.com/article.aspx?articleid=2484345) found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women. The American Congress of Obstetricians and Gynecologists has also called for more depression screening of pregnant and postpartum women and referral for evidence-based therapy.
Timing: Strike While the Iron is Hot
In spite of the consensus, screening for maternal depression is not standard or routine. We know that there are many models of effective collaborative/integrated care that are embedded into routine care at women’s health clinics, OB-GYN, and/or pediatric clinics, as well as targeted interventions in early childhood programs, such as home-visiting or Early Head Start programs. Various studies show that contacts in different treatment settings are potential opportunities for the screening, even if only using a two-question paper-based screen (http://www.ncbi.nlm.nih.gov/pubmed/15956865), to achieve a diagnosis of, and referral for, treatment of maternal depression. We need to conduct routine maternal depression screening during all points of possible contact, from prenatal visits through well-child visits.
It’s time for screening to become routine. We need to conduct routine maternal depression screening during all points of possible contact, from prenatal visits through well-child visits. Doing so, improves detection of mothers who are willing to discuss depression and stress issues with their physician. Further, screening should be facilitated by a collaborative care infrastructure, such as discussed in Beacon’s white paper, where everyone has a role. For example, as a managed behavioral health organization, Beacon works with many of its health plan partners to address perinatal depression by collaborating on perinatal teams and screening pregnant and postpartum members with the Edinburgh Postnatal Depression Scale. In Massachusetts, Beacon’s Massachusetts Child Psychiatry Program (MCPAP) launched its MCPAP for Moms (https://www.mcpapformoms.org/) program to help physicians treating pregnant and postpartum women and their children to identify and manage depression up to one year after delivery. Another example is New York City (https://thrivenyc.cityofnewyork.us/), where a new initiative is underway between NYC Health + Hospitals and Maimonides to develop a citywide effort at universal screening and care for women experiencing material depression.
In brief, screening is the logical thing to do and the necessary thing to do. We must follow New York City’s example and embrace the goal of universal screening, starting in our own communities, so that we can treat maternal depression, once and all.
This article was printed with permission from the Beacon Lens Blog and can be visited at http://beaconlens.com/helping-moms-and-kids.