Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

AAP Says What!?: Post-Partum Depression Screening

Michael Cosimini, MD and Liza Green Golan Mackintosh, MD
00:00
16:24

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Michael and Liza discuss the updated AAP clinical report for post-partum depression screening that was released January of 2019, and discuss the importance of the pediatrician screening women for this perinatal mood and anxiety disorder in their clinics. They discuss when to screen, how to screen, and what resources are available for referral, in addition to discussing the effects of maternal depression on infants.

  • Perinatal depression (PND)  is any depressive episode that occurs during pregnancy or within a year of giving birth. 

  • The AAP in its 2019 policy statement advocates that Pediatricians screen for postpartum depression  (PPD) at one, two, four, and six months. More recent studies also advocate for screening at all inpatient admissions and ED visits for all infants under one.

  • It is estimated that between 12% and 15% of moms will have perinatal depression with studies suggesting that up to 25% of women who are in low-income socioeconomic status having perinatal depression.

  • The mother-infant  dyad really is the responsibility of the  pediatrician given the direct effect of maternal (and paternal) well-being on a child.

  • Screening tools for PPD include the Edinburgh Postpartum Depression Scale (EPDS)  or the Patient Health Questionnaire (PHQ).

    • The EPDS is a ten question questionnaire and includes two questions related to anxiety. A score of 10 or more is suggestive of depression.

    • The PHQ works by asking two questions and if those are positive then a full nine PHQ is completed. 

    • There are certain questions on both the EPDS and the PHQ that assess suicidality and elements of psychosis. If those are positive an immediate mental health referral and urgent care is needed.

  • Pediatricians should familiarize themselves with community resources to help address a positive depression screen .

  • The AAP recommends that a brief intervention be done when a positive screen is found. this may include: 

    • promoting the strength of the mother-infant relationship

    • encouraging the mother and reassuring her regarding any feeding concerns

    • encouraging understanding and responding to the infant’s cues

    • promoting realistic expectations and prioritizing important things

    • encouraging social connections

  • A personal history of depression, a history of perinatal mood or anxiety disorder in a previous pregnancy, family history of depression, marital discord, family violence, isolation, difficult infant temperament, and young maternal age increase the risk of PND. In addition, the risk is also higher with multiple births, preterm birth, and a special needs infant. 

  • The policy statement recommends that partners be screened at the six month visit.  In person screening is best but a copy of the EPDS or a PHQ can be sent home and brought back at the next visit. The reason that the screening of partners is important is that the presentations of PND in fathers or partners can be more subtle but can also be more violent.

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Hippo Peds RAP September 2019 Written Summary 369 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

3.25 AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate