Why Screen for Postpartum Depression?
By: Karmel Choi, PhD
Over one in 10 new moms* - or more than 400,000 women in the US every year (based on 2016 estimates) - experience postpartum depression. Postpartum depression is more than just the typical “blues” after childbirth. It is a clinical condition that often goes undetected because its symptoms can be mistaken for the normal tribulations of hormonal changes and sleepless nights that tend to accompany early weeks of parenting.
But what are the consequences of postpartum depression? And what can be done to address it? As someone who has studied postpartum depression for several years now, I want to share some ideas about ways to spot depression in new moms, and why such efforts are so important.
Postpartum depression affects more than just moms.
Adapted from https://pngtree.com/freepng/family-tree_2668816.html.
Postpartum depression is a two-generation issue: it affects moms and their babies. For example, mom’s depressive symptoms (e.g., sadness, or feeling foggy) can get in the way of her responsiveness—that is, her attention to baby’s cues, accurate reading of baby’s needs, and flexible responses to meet those needs. These are all key ingredients for child development.
Research suggests that moms with postpartum depression find it more difficult to bond emotionally with their babies, and can behave differently with their babies during play and other interactions. The brains of moms with postpartum depression have also been shown to activate less to emotional infant cues like smiling or crying, which are important signals for healthy attachment. This is not to say that women with postpartum depression do not care well for their babies—rather, depression makes these vital processes more tiring and difficult.
Postpartum depression confers long-term risk.
The effects of postpartum depression can linger well beyond the first year after childbirth, and have far-reaching consequences for kids and their moms.
In one of my studies, I found that postpartum depression predicts child problems 12 years down the road, mostly because experiences of postpartum depression can lead to mom experiencing ongoing depression throughout the child’s life—as other studies have also found. In other words, having postpartum depression signaled mom’s risk of having depression in the future, with impacts on child long-term health.
Other studies have suggested that postpartum depression may affect later child development even if mom’s depression gets better, as the first year of life could be a “sensitive period” where the foundations of brain health are being laid.
Postpartum depression happens during a window of opportunity.
By catching mom’s depression early, we may be able to interrupt its consequences.
After childbirth, women routinely see health providers, whether for themselves at check-ups or for their babies at pediatrician visits. This means we could use these regular checkpoints to identify women experiencing postpartum depression. In fact, it may even be possible to screen for depression during pregnancy to identify women at high risk for postpartum depression.
Women who have struggled silently in the past with depression may also be more open to seeking mental health care during the postpartum period because they want to do all they can to take care of their baby.
So we should screen for postpartum depression.
What if we could routinely ask postpartum women a standard set of questions about their mood and functioning—and direct those who are struggling to providers and other resources who could help? According to Postpartum Support International, an organization devoted to promoting emotional well-being across pregnancy and postpartum, there are at least two freely available, scientifically validated screening tools for postpartum depression that could be administered by providers in under five minutes.
But there are barriers to screening.
Primary care docs and pediatricians are two types of providers that are well positioned to catch postpartum depression early. But they are often strapped for time and have to cover a lot in one visit. They might even be nervous to ask if a woman is experiencing depressive symptoms, out of fear of not knowing how to intervene.
As a society, we can do more to promote screening and care for postpartum depression.
We need to make it easy for providers to ask about postpartum depression. Although simple screening tools now exist, not all providers are aware or feel comfortable using them. We can support organizations like PSI and state agencies that promote these tools to the public and work to train providers.
We need to make it clinically viable to ask about postpartum depression. This means continuing to support research for postpartum depression treatment and help make sure there are referral pipelines in place. STEP-PPD provides online training materials for primary care professionals who want to ask about postpartum depression, including how to set up a referral network.
We need to make it financially sensibleto ask about postpartum depression. Thankfully, some states have been working on this. For example, Medicaid agencies in Illinois, Colorado, and Virginia cover depression screenings in new mothers as part of well-child visits. In Massachusetts, pediatricians could submit insurance claims for assessing mom’s postpartum depression using a standardized tool. We can continue to advocate for expanding these benefits at the state/federal levels and with insurance providers.
Postpartum depression is a tough condition that affects more women than we may even know. By screening for mom’s depression during the earliest days after delivery, we could make a difference for women and their babies not just immediately, but for years to come.
Notes:
*We focus on moms here, but research suggests that dads can get postpartum depression too.