Treat postpartum depression in the pediatrician’s office

Last week, the US Task Force for Preventative Services released its recommendations on routine screening of pregnant and postpartum women for depression. The new guidelines are welcome and long anticipated by those of us working in the field of infant mental health. According to the National Academy of Sciences, at least 15 million children in the U.S., about one in five, live in households with parents who have major or severe depression. Researchers have years’ worth of data, from research and clinical practice, on the struggles faced by families who are confronted with mood disorders during and after pregnancy. As we focus very well-deserved attention on increased screening, practitioners, policymakers, and parents need to make sure we do not stop there. We need to direct our efforts to figuring out the services that will help families thrive.

Postpartum depression can be devastating for mothers, and in turn, their babies. From birth, infants grow and thrive in relationships. The bonding and caretaking that takes place early in life paves the way for many positive health and mental health outcomes in later years. The evidence is robust and compelling: early relationships are essential to our health and well-being. Children who grow up with depressed mothers are more likely to develop behavior, academic and health problems. However, studies have demonstrated that treating maternal depression reduces the risks for these negative outcomes. So when we think about treatment, let’s go beyond focusing on mom and turn our lens towards mothers and children.

{mosads}While individual treatment for women is essential and necessary, it should also be a catalyst to examine how depression may be affecting the early parent-child relationship. This is possible with two-generation treatment, which considers the risk for both parents and babies, and can have a synergistic effect by ensuring that everyone’s needs are addressed and that early relationships become the foundation for healthy development.

An innovative and exciting way to offer services to mothers and babies together is to integrate mental health services in pediatric clinics. New parents spend a lot of time in the pediatrician’s office, and there is no stigma associated to bringing your child to this doctor; on the contrary, you are regarded as a responsible parent. So why not use this natural environment for babies and mothers to receive more holistic care? On average, a parent will be in the pediatrician’s office at least eight times during their child’s first year. We should capitalize on these visits and ensure we are taking care of the needs of parents, who directly impact children.

This has been done successfully through Montefiore’s Healthy Steps program in the Bronx, NY. Since 2009, parental mental health services have been provided within the pediatric primary care practice to parents of young children. All parents are screened for depression during their child’s 2- and 24-month visit. If they screen positive and are interested in therapy, it is provided onsite, and always focuses on the parent’s ability to care for herself, and care for her baby. While these are the formal points of screening, a parent may request services at any other point.

If an organization doesn’t have the capacity to provide integrated parental mental health within pediatrics, there are certainly other options. For example, Early Head Start programs which offer comprehensive services to low income families from pregnancy to the age of 3, are particularly well positioned to offer mental health services to vulnerable families.  Columbia University Early Head Start in New York City has clinical social workers on staff who screen pregnant and postpartum women and offer treatment and additional referrals as needed. Families attend Early Head Start programs, at minimum, on a weekly basis, and the incidence of depression amongst Early Head Start mothers nationally is estimated to be above 40% during the child’s first year of life. Other alternatives include home visiting programs, mobile mental health vans, tele-therapy, and embedding maternal mental health services in other early childhood programs.

As we recognize the critical importance of providing services to women experiencing depression, anxiety, and a myriad other mental health problems, let’s not forget about the needs of babies. Indeed, the two are, as we all know, intimately intertwined. We must creatively think about how to offer services to families where they are. These programs will flourish with increased awareness and appropriate funding streams to allow provision of services within their current structure (e.g. pediatric medical home, Early Head Start). We must recognize the risk to young children when their parents are suffering from mental health problems. The science is robust, the risk is significant, and the call to action is here.

Duch is assistant professor of Population and Family Health at the Mailman School of Public Health, Columbia University. Briggs is associate professor of Pediatrics and director of the Pediatric Behavioral Health Service at Montefiore Medical Group.