The Pediatric Emergency Department: Another Opportunity for Postpartum Screening

Earlier this year, the U.S. Preventive Services Task Force (USPSTF) released recommendations on Screening for Depression in Adults. The Task Force recommends that clinicians screen ALL ADULTS for depression and notes that the evidence indicates that screening in the primary care setting is beneficial. Echoing the recommendations made by the American College of Obstetricians and Gynecologists last year, the USPSTF highlights the importance of screening in populations at particularly high risk for depression: pregnant and postpartum women.

Recognizing the negative effects of maternal depression on the wellbeing and development of children, the American Academy of Pediatrics also recommends routine screening for postpartum depression in new mothers.  Most of this screening will take place in the setting of routine well baby visits; however, this approach might miss certain vulnerable populations.  Given that the pediatric emergency department (PED) is where many vulnerable, high-risk populations receive their medical care, a recent research study has explored the possibility of using the PED as a site to screen for postpartum depression.

In this study, 121 mothers (mean age=28 ± SD 6 years; 86% English vs. Spanish language; 50% non-Hispanic Black race/ethnicity; 75% non-private insurance) were screened for PPD during visits to the ED with their infant (mean age = 3 months) using the Edinburgh Postnatal Depression Scale (EPDS).  Mothers who screened positive for PPD were contacted for phone follow-up at one month.

Twenty-seven mothers (22%) screened positive for PPD with eight mothers (7%) reporting suicidal thoughts. Forty-seven percent (57/121) of the mothers had never received screening prior to that visit.  The infants of PPD-screened positive mothers had more ED visits than those whose mothers screened negative (median 2 vs. 1).

Most importantly, 74% (90/121) of the participants viewed ED-based PPD screening favorably.  What we don’t really know is whether the screening influenced access to care and rates of treatment.  The researchers attempted to contact the mothers with positive screens but were only able to reach 12 of the 57 mothers.  Most endorsed positive impact of screening, including increased access to support (8/12, 67%) and improved activities of daily living (10/12, 83%).

While screening is important, we must also make sure we tend to the construction of a system that provides appropriate follow-up and treatment.   Because stigma continues to be significant with regard to mental health issues in mothers and mothers-to-be and because there are concerns regarding the use of medication in pregnant and nursing women, we must make sure that after screening, we help women to access appropriate resources and treaters who have expertise in the treatment of women during pregnancy and the postpartum period.

Ruta Nonacs, MD PhD

Jarvis L, Badolato G, Breslin K, Goyal M. (2016). 16: POSTPARTUM DEPRESSION SCREENING IN A PEDIATRIC ED. Journal of Investigative Medicine, 64(3), 813.