October 16, 2018
Doctor with female patient

Screening for Maternal Depression

by Keng Lam, MD  

The topic of postpartum depression gets a lot of attention in the media and among obstetricians. But is the ob-gyn office really the best place to screen for maternal depression? Research suggests not. Maternal depression may be better screened in pediatric clinics; and depression after having a child may last much longer in some women than we thought.

Back in 2010, the American Academy of Pediatrics recommended that pediatricians start screening mothers for postpartum depression, refer depressed moms to community resources for treatment, and provide support for the mother-child relationship. Erik Fernandez y Garcia, MD, associate professor of clinical pediatrics at the University of California, Davis, took that recommendation and developed the Motivating our Mothers (MOM) intervention to show that pediatricians can play an important role in helping mothers who develop postpartum depression.

In a pilot randomized control trial published in Academic Pediatrics, Dr. Fernandez y Garcia and colleagues enrolled 104 English-speaking moms who came to a general pediatrics clinic at UC Davis Children’s Hospital. All mothers in the study indicated they might be depressed based on a simple two-question screening survey. The MOM intervention group received written and verbal information about depression targeted specifically to parents, and a structured motivational follow-up phone call. Mothers in the control group received general education about depression and a follow-up phone call.

There were three major differences in the study protocol between the MOM group and the control group. First, along with education about maternal depression, the MOM mothers received motivational messages about how they could improve their child’s health by receiving depression treatment themselves. Second, clinic staff used a conversational approach with MOM mothers, compared to a lecture given to control group mothers. Third, the control group mothers’ follow up call was a simple survey, without any motivational message.

The results? Mothers from the MOM intervention group were 20 percent more likely to contact a resource for follow-up care for depression. While the sample size was small and more studies are needed to confirm the findings, this pilot suggests that pediatricians can play an important role in diagnosing postpartum depression.

“Women parenting young children don’t go to doctors for themselves. They are young and they are busy,” Dr. Fernandez y Garcia explains.

The MOM study also did something that few others did: it enrolled moms whose children were up to age 12, instead of focusing solely on mothers of newborn babies. This led to the study’s most surprising finding: maternal depression is not something that only occurs shortly after childbirth.

Another study, published in BJOG: An International Journal of Obstetrics & Gynaecology, followed more than 1,500 Australian women from six public hospitals and found that “maternal depression is more common at four years postpartum than at any time in the first 12 months postpartum.”

“When you think of maternal depression, don’t just think of postpartum,” Dr. Fernandez y Garcia says. It’s important to screen mothers of children at all ages for depression, and the pediatrician is usually the doctor mothers see most often. Getting help early is good for the entire family.