Can Postpartum Depression Be Managed in Pediatric Primary Care?

Olin, S. Serene; Kerker, Bonnie D.; Stein, Ruth E.K.; Weiss, Dara; Whitmyre, Emma D.; Hoagwood, Kimberly; Horwitz, Sarah M.

doi:10.1089/jwh.2015.5438

Cited by 32 publications

(30 citation statements)

References 69 publications

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“…Successful referral and treatment is possible in primary care settings. 39 These reasons support the strong level of screening occurring in pediatric practice.…”

Section: Discussionmentioning

confidence: 89%

Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

Morgenlander¹,

Tyrrell

Garfunkel

et al. 2019

Academic Pediatrics

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BACKGROUND: The American Academy of Pediatrics and the Academic Pediatric Association have published guidelines supporting screening and referral for social determinants of health (SDH) in pediatric primary care. Despite this charge, little is known about the current prevalence of screening practices taking place in medical homes across the country.OBJECTIVE: The objective of this study is to describe current practices for systematically screening for social determinants of health in nationwide pediatric continuity clinics enrolled in the CORNET network. METHODS: We recruited 144 pediatric resident continuity clinics enrolled in the ContinuityResearch Network (CORNET) of the Academic Pediatric Association. Continuity clinic directors at 75 sites agreeing to participate received an electronic survey instrument requesting clinic demographics and information on screening and educational practices for fifteen social determinants of health. RESULTS:In the sixty-four clinic sites that responded to the survey, the range of SDH being screened for was 0-15 with a mean of 7. The most commonly screened SDH were maternal depression (86%), child education (84%), food insecurity (71%) and firearm exposure (65%).Most commonly, screening instruments are paper documents original to the clinic. Primary iii providers, nurses or medical assistants administer the majority of screens on rooming or during the encounter. Clinics not currently screening have plans to begin screening for nearly a quarter of those SDH not currently being screened within the next 3 years. Clinic directors most often cited lack of time (63%), lack of resources to address positive screen (50%) and inadequate training (46%) as barriers to SDH screening. Less than 10% of resident continuity clinic directors cited lack of indication or evidence for screening as barriers. CONCLUSIONS: Screening for SDH in pediatric resident continuity clinics has not yet been universally implemented. Screening practices are variable reflecting the complex nature of screening and the heterogeneity of the various SDH. Characteristics of commonly screened SDH include validated, concise screening tools, longstanding Bright Futures recommendations, literature suggesting benefit, and identifiable interventions. The major barriers to SDH screening are lack of time and lack of resources to address positive screens. A variety of measures including comprehensive, concise screening tools, up-to-date community resource guides, streamlined referral processes, embedded multidisciplinary teams, and strong community partnerships could mitigate these barriers.

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“…Successful referral and treatment is possible in primary care settings. 39 These reasons support the strong level of screening occurring in pediatric practice.…”

Section: Discussionmentioning

confidence: 89%

Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

Morgenlander¹,

Tyrrell

Garfunkel

et al. 2019

Academic Pediatrics

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“…Even brief psychosocial interventions within primary care settings have shown to be efficacious. 129 Recent studies have revealed that supports to increase maternal engagement and responsiveness can reverse gene expression patterns related to stress via epigenetic pathways and, thereby, buffer initial adverse effects of perinatal depression (DNA methylation and neuroendocrine functioning). 130…”

Section: Effect On the Childmentioning

confidence: 99%

“…A total score of 10 or more on the EPDS is a positive screen indicating a concern for depression, which necessitates further discussion in which providers can clarify the findings, determine acuity of concerns, and, if necessary, make appropriate referrals for further assessment and treatment of the parent (as described below). 129,163 It is important to note that similar to all screening tools, the EPDS is not a diagnostic instrument. In situations in which there is any indication of suicidal ideation (on the EPDS question 10 or in discussion), if the parent expresses concern about his or her ability to maintain the infant's safety, or if the pediatric provider suspects that the parent is suicidal or homicidal, it is considered a positive screen that warrants an immediate evaluation for safety of the parent and/or infant, often in an emergency psychiatric setting.…”

Section: Perinatal Depression Screening Toolsmentioning

confidence: 99%

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Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice

Mattson²,

et al. 2018

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Perinatal depression is the most common obstetric complication in the United States, with prevalence rates of 15% to 20% among new mothers. Untreated, it can adversly affect the well-being of children and families throught increasing the risk for costly complications during birth and lead to deterioration of core supports, including partner relationships and social networks. Perinatal depression contributes to long-lasting, and even permanent, consequences for the physical and mental health of parents and children, including poor family functioning, increased risk of child abuse and neglect, delayed infant development, perinatal obstetric complications, challenges with breastfeeding, and costly increases in health care use. Perinatal depression can interfere with early parent-infant interaction and attachment, leading to potentially long-term disturbances in the child's physical, emotional, cognitive, and social development. Fortunately, perinatal depression is identifiable and treatable. The US Preventive Services Task Force, Centers for Medicare and Medicaid Services, and many professional organizations recommend routine universal screening for perinatal depression in women to facilitate early evidence-based treatment and referrals, if necessary. Despite significant gains in screening rates from 2004 to 2013, a minority of pediatricians routinely screen for postpartum depression, and many mothers are still not identified or treated. Pediatric primary care clinicians, with a core mission of promoting child and family health, are in an ideal position to implement routine postpartum depression screens at several well-child visits throughout infancy and to provide mental health support through referrals and/or the interdisciplinary services of a pediatric patient-centered medical home model.

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“…Although studies have not explored a pediatric role in depression screening and referral from the fathers' perspective, there is evidence that maternal postpartum depression can be adequately managed within pediatric primary care. 5 Nevertheless, overall screening rates are low, and 80% of pediatric residents report not receiving any training to manage adult mental health problems. 6 This finding underscores opportunities to educate physicians about the importance of depression in both parents and to develop strategies to integrate screening tools into routine care.…”

Section: Prevalence Of Depression Among Fathers At the Pediatric Wellmentioning

confidence: 99%

Prevalence of Depression Among Fathers at the Pediatric Well-Child Care Visit

Downs

Carroll

2018

JAMA Pediatr

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Can Postpartum Depression Be Managed in Pediatric Primary Care?

Abstract: Postpartum depression can be managed within PPC. Psychosocial strategies can be integrated as part of anticipatory guidance. Critical supports for primary care clinicians, especially in pediatric practices, are needed to improve access to timely nonstigmatizing care.

Cited by 32 publications

References 69 publications

Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice

Prevalence of Depression Among Fathers at the Pediatric Well-Child Care Visit

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