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

Tools

Response to a Positive Screen

Resources

Authors

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