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Maternal Depression Screening

Maternal depression affects up to 18% of mothers during the first year after delivery when a pediatrician may be the only doctor a woman sees. Pediatric providers have the opportunity to identify and intervene through routine screening of mothers for depression at the child's well-child visit.

Bright Futures encouraged pediatricians to take additional steps to support families during the routine well-child visits. Because "maternal psychological distress is likely to go unrecognized and untreated by a mother's own health care provider, "pediatricians are often in a better position to deal with problems impacting the family by dealing with the mothers' of their young patients." [Lueder: 2005] The pediatrician can effectively screen for maternal depression. [Onunaku: 2005]

As more information is learned about infant mental health, more attention is being given to strengthening the bond between the mother and child. Maternal depression can significantly affect that bond and place the infant at risk for delays in social and emotional development.

Other Names

  • Post partum deprression
  • Maternal psychological stress
  • Postnatal depression
  • Baby blues (term generally for very mild and transient forms of maternal depression)
  • Post partum psychosis (term generally reserved for very severe forms of maternal depression)

Early Signs

Maternal depression spans the continuum from mild baby blues to the more serious condition of post partum psychosis. Warning signs may vary according to the diagnosis and may include:
  • Lack of enjoyment of usual activities;
  • sleeping more;
  • insomnia;
  • self-doubt;
  • avoidance of social situations including daily activities of grocery shopping and taking children to school;
  • seclusion from family;
  • neglect of the newborn infant or other children; and
  • self-inflicted injuries.

ICD-9

296.2, Major depressive disorder single episode

296.3, Major depressive disorder recurrent episode

296.82, Atypical depressive disorder

300.4, Dysthymic disorder

309.0, Adjustment reaction with adjustment disorder with depressed mood

309.1, Adjustment reaction with prolonged depressive reaction

309.28, Adjustment disorder with mixed anxiety and depressed mood

311, Depressive disorder not elsewhere classified

Code 296.2 includes codes 296.2-296.25, and code 296.3 includes codes 296.30-296.35. [Dietz: 2007]

CPT

64840, Mental disorder pregnancy unspecified

Guidelines

The American Academy of Pediatrics recommends "routine, brief, maternal depression screening conducted during well-child visits." [Olson: 2006]

Tools

A standardized and validated tool is recommended.

Patient Health Questionnaire 9 (PHQ-9)

Description: A 9-question screening tool for depression. Sensitivity=88%; specificity=88%. [Kroenke: 2001]

Source: Can be downloaded in pdf format in English or Spanish from the MacArthur Initiative on depression & Primary Care site at Patient Health Questionnaire (MacArthur Initiative), click on "Reproduction Quality Blank PHQ" (both files include English-language instructions for use and scoring of the questionnaire). Can also be downloaded in English and several other languages (but not Spanish) from the Pfizer Inc. site, www.phqscreeners.com; scoring instructions can be downloaded separately from the same page. Free, may be printed without permission.

Patient Health Questionnaire 2 (PHQ-2)

Description: A 2-question version of the PHQ-9. Sensitivity=96%; specificity=57%. [Thibault: 2004]

Source: Can be downloaded in English directly from the Utah Department of Health, Patient Health Questionnaire 2 (PDF Document) . The two questions are: 1) During the past month, have you often been bothered by feeling down, depressed, or hopeless? and 2) During the past month, have you often been bothered by little interest or pleasure in doing things? If the answer to either is "yes" the screen is positive. Free, may be printed without permission.

Edinburg Postnatal Depression Scale

Description: A validated, quick, 10-question screening tool for maternal depression to be used by primary care providers and includes scoring instructions. Sensitivity 65-100%; specificity 49-100%. [Eberhard-Gran: 2001]

Source: www.dbpeds.org Free, may be printed without permission.

Response to a Positive Screen

Primary Care

Upon positive screen:
  • Evaluate the infant using a social-emotional screening tool;
  • Evaluate the infant for poor feeding;
  • Evaluate the mother to determine the severity of the maternal depression; and
  • Refer the mother to a mental health professional for further assessment and evaluation.

Specialty Care

Initial consultation, assessment, and evaluation by a mental health professional (social worker, psychiatric-mental health nurse practitioner, psychologist, or psychiatrist). A psychiatric-mental health nurse practitioner or psychiatrist may work with the mother to devise a medication management plan, if necessary.

Resources

Information & Support

For Professionals

Medicaid Information Bulletin, 2006 (PDF Document 165 KB)
This bulletin contains recommended depression screening tools for Utah Medicaid Providers, when to use the tools, and links to the tools including the 9-question Public Health Questionnaire (PHQ-9), Edinburg, Beck Depression Inventory-II, and the Family Psychosocial Screen (FPS).

Depression Tool Kit (MacArthur Foundation Initiative on Depression and Primary Care)
Designed for primary care practices to help in the diagnosis and management of maternal depression; contains screening tools, patient handouts, medication information, resources, and references and includes the 9-question Public Health Questionnaire (PHQ-9). Available for download upon agreement to terms.

Utah Reproductive Health Program
This program, within the Utah Department of Health, provides information; newsletters; tools; handouts; posters; and links for women, families, and providers about reproductive health issues.

Maternal Depression Poster (PDF Document 90 KB)

For Parents and Patients

Post Partum Depression and the Family Poster (PDF Document 65 KB)

Services

Child Psychiatry

See all Child Psychiatry services providers (19) in our database.

Mental Health Clinics, Public

See all Mental Health Clinics, Public services providers (27) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors

Author: Kathleen Smart LCSW, 9/2006
Contributing Author: Alfred Romeo RN, PhD, 4/2008
Content Last Updated: 4/2008

Page Bibliography

Dietz PM, Williams SB, Callaghan WM, Bachman DJ, Whitlock EP, Hornbrook MC.
Clinically identified maternal depression before, during, and after pregnancies ending in live births.
Am J Psychiatry. 2007;164(10):1515-20. PubMed abstract / Full Text

Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO.
Review of validation studies of the Edinburgh Postnatal Depression Scale.
Acta Psychiatr Scand. 2001;104(4):243-9. PubMed abstract / Full Text

Kroenke K, Spitzer RL, Williams JB.
The PHQ-9: validity of a brief depression severity measure.
J Gen Intern Med. 2001;16(9):606-13. PubMed abstract / Full Text

Lueder GT, Silverstein J.
Screening for retinopathy in the pediatric patient with type 1 diabetes mellitus.
Pediatrics. 2005;116(1):270-3. PubMed abstract / Full Text

Olson AL, Dietrich AJ, Prazar G, Hurley J.
Brief maternal depression screening at well-child visits.
Pediatrics. 2006;118(1):207-16. PubMed abstract / Full Text

Onunaku, Ngozi.
Improving maternal and infant mental health: Focus on maternal depression.
National Center for Infant and Early Childhood Health Policy at UCLA. July. / http://www.healthychild.ucla.edu/PUBLICATIONS/Maternal%20Depression%20...

Thibault JM, Steiner RW.
Efficient identification of adults with depression and dementia.
Am Fam Physician. 2004;70(6):1101-10. PubMed abstract / Full Text