Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
    • Supplements
    • Publish Supplement
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • Log out
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
    • Supplements
    • Publish Supplement
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers

Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics

revised

  • e20183260
From the American Academy of PediatricsClinical Report

Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice

Marian F. Earls and The Committee on Psychosocial Aspects of Child and Family Health
Pediatrics November 2010, 126 (5) 1032-1039; DOI: https://doi.org/10.1542/peds.2010-2348
Marian F. Earls
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • Comments
Loading
Download PDF

Abstract

Every year, more than 400 000 infants are born to mothers who are depressed, which makes perinatal depression the most underdiagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship. This system would have a positive effect on the health and well-being of the infant and family. State chapters of the American Academy of Pediatrics, working with state Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and maternal and child health programs, can increase awareness of the need for perinatal depression screening in the obstetric and pediatric periodicity of care schedules and ensure payment. Pediatricians must advocate for workforce development for professionals who care for very young children and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.

  • postpartum depression
  • perinatal depression
  • Edinburgh Postpartum Depression Scale
  • medical home
  • dyad relationship
  • paternal depression

BACKGROUND

Maternal and paternal depression affect the whole family.1 This report will specifically focus on the impact of maternal depression on the young infant and the role of the primary care clinician in recognizing perinatal depression. Perinatal depression is a major/minor depressive disorder with an episode occurring during pregnancy or within the first year after birth of a child. A family history of depression, alcohol abuse, and a personal history of depression increase the risk of perinatal depression.2

The incidence of perinatal depression varies with the population surveyed, but estimated rates for depression among pregnant and postpartum women have ranged from 5% to 25%. Studies of low-income mothers and pregnant and parenting teenagers have reported rates of depressive symptoms at 40% to 60%. In general, as many as 12% of all pregnant or postpartum women experience depression in a given year, and for low-income women, the prevalence is doubled.1 The rate of major and minor depression varies during pregnancy from 8.5% to 11.0%, and in the first year after birth of a child, the rate ranges from 6.5% to 12.9%; the rate of major depression during pregnancy ranges from 3.1% to 4.9%, and in the first year after birth of a child, the rate ranges from 1.0% to 6.8%. The timing shows a peak of 6 weeks after birth of a child for major depression and 2 to 3 months for minor depression.2 There is another peak of depression 6 months after birth of a child.

The spectrum of depressive symptoms in the postpartum period ranges from “maternity blues” to postpartum depression and postpartum psychosis. Maternity blues affects 50% to 80% of new mothers and occurs during the first few days after delivery. Symptoms include crying, worrying, sadness, anxiety, and mood swings. Symptoms are usually gone after a few days or within 1 to 2 weeks. It does not impair function and can be treated with reassurance and emotional support. Postpartum depression occurs in 13% to 20% of women after birth. It meets the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for depression and is distinct from maternity blues.3

Postpartum psychosis affects approximately 1 to 3 mothers of 1000 deliveries and most often occurs in the first 4 weeks after delivery. Mothers with postpartum psychosis are severely impaired and may have paranoia, mood shifts, hallucinations, delusions, and suicidal and homicidal thoughts. This is a serious condition that requires immediate medical attention and usually hospitalization. Preexisting bipolar disorder is a risk factor for developing postpartum psychosis.

Depression: A Family Issue

Fathers

Paternal depression is estimated at 6%.4 Eighteen percent of fathers of children in Early Head Start had symptoms of depression. In an 18-city study, depressed fathers had higher rates of substance abuse.5 The rate of paternal depression is higher when the mother has postpartum depression, which compounds the effect on children.5,6 A nondepressed father has a protective effect on children of depressed mothers and is a factor in resilience.7,–,9

Family

Perinatal depression may be comorbid with marital discord, divorce, family violence (verbal and/or physical), substance use and abuse, child abuse and neglect, failure to implement the injury-prevention components from anticipatory guidance (eg, car safety seats and electrical plug covers),10 failure to implement preventive health practices for the child (eg, Back to Sleep),10,–,13 and difficulty managing chronic health conditions such as asthma or disabilities in the young child.11,14 Families with a depressed parent (ie, any parental depression) overutilize health care and emergency facilities.14 Studies of families of a person with major depression that began before 30 years of age demonstrate that the parent, siblings, and children are 3 to 5 times more likely to have major depression themselves. It is likely that some types of depression have genetic determinants.

THE IMPACT OF MATERNAL DEPRESSION ON THE INFANT

Maternal postpartum depression threatens the mother-child (dyad) relationship (attachment and bonding) and, as such, creates an environment for the infant that adversely affects the infant's development. The processes for early brain development— neuronal migration, synapse formation, and pruning—are responsive to and directed by environment as well as genetics. For example, it is known that an infant living in a neglectful environment, which is common with depressed mothers, can have adverse changes visible on MRI of the brain.15,16 Infants who live in a setting of depression are likely to show impaired social interaction and delays in development. If the maternal depression persists untreated and there is not intervention for the mother and the dyadic relationship, the developmental issues (particularly attachment) for the infant also persist and are likely to be less responsive to intervention over time.17 Addressing maternal depression in a timely and proactive fashion is essential to ensure healthy early brain and child development and readiness to succeed.18

In their evidence report, “Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries,”19 the Agency for Healthcare Research and Quality reviewed 6 prospective cohort studies regarding postpartum depression and breastfeeding. It revealed an association between not breastfeeding, or early cessation of breastfeeding, and postpartum depression. The report noted that “it is plausible that postpartum depression led to early cessation of breastfeeding as opposed to breastfeeding altering the risk of depression.” It also noted that both effects might occur and that further investigation is needed to assess the nature of this association.

The consequences of maternal depression include negative effects on cognitive development, social-emotional development, and behavior of the child. Language acquisition depends on the number of words used by the family, playing, and having fun and cuddling with the infant and child,20 which are likely to occur less frequently in the family of a depressed mother. As early as 2 months of age, the infant looks at the depressed mother less often, shows less engagement with objects, has a lower activity level, and has poor state regulation. Infants are at risk for failure to thrive, attachment disorder (deprivation/maltreatment disorder of infancy as defined the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: DC0-3R21), and developmental delay on the Bayley Scales of Infant Development at 1 year of age. Such infants are at risk for insecure attachment, which is associated with later conduct disorders and behavior problems. Maternal depression impairs parenting skills and can affect attention to and judgment regarding child supervision for safety and health management. The presence of other risks to healthy parenting, such as poverty, substance abuse, domestic violence, and previous trauma, in addition to depression, creates an increased cumulative risk. The infant's temperament is another factor, which may increase parental stress (difficult temperament) or impart resilience for the infant (easy temperament). Maternal depression in infancy predicts a child's likelihood of increased cortisol levels at preschool age, which in turn has been linked with internalizing problems such as anxiety, social wariness, and withdrawal.22 Behavior problems, attachment disorders, depression, and other mood disorders in childhood and adolescence can occur more frequently in children of mothers with major depression.

Treating a mother's depression is associated with improvement of depression and other disorders in her child.24 The STAR*D–Child (Sequenced Treatment Alternatives to Relieve Depression–Child) project is a study that began in December 2001 and followed 151 mother-child pairs in 8 primary care and 11 psychiatric outpatient clinics across 7 regional centers in the United States. The children were assessed every 3 months. The researchers concluded that “continued efforts to treat maternal depression until remission is achieved are associated with decreased psychiatric symptoms and improved functioning in the offspring.”24,25

THE ROLE OF THE PRIMARY CARE PROVIDER

Many experts see a role for primary care practices in screening for depression, in general, and specifically for postpartum depression. The 1999 report of the Surgeon General on mental health,26 the 2000 report of the Surgeon General's Conference on Children's Mental Health,27 and Bright Futures guidelines28 call for early identification and treatment of mental health problems and disorders. In a recent policy statement, “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,” the American Academy of Pediatrics (AAP) also recognized the unique advantage of the primary care clinician for surveillance, screening, and working with families to improve mental health outcomes.29 The AAP Medical Home Initiative30 and the AAP policy statement on the family31 addressed family-centered pediatric care. The President's New Freedom Act of 2004 states that early screening, assessment, and treatment of mental health problems must become a national goal.32 Using data from the National Evaluation of Healthy Steps for Young Children (in the Healthy Steps practices, mothers were assessed for depression), the effect of maternal depressive symptoms on the children's receipt of well-child care was assessed. Minkovitz et al concluded that “Increased provider training for recognizing maternal depressive symptoms in office settings, more effective systems of referral, and development of partnerships between adult and pediatric providers could contribute to enhanced receipt of care among young children.”33

A recent study from the University of Pittsburgh followed 731 families to examine the effect of intervention for maternal depression on behavior outcomes for children at the ages of 3 and 4 years. The researchers concluded that “reductions in maternal depression mediated improvements in both child externalizing and internalizing problem behavior.”23

The majority of pediatricians agree that screening for perinatal depression is in the scope of pediatric practice.34 In a survey by Olson et al,35 few of the pediatricians felt that they were responsible for diagnosis and management, but the majority reported that they had provided brief interventions. Most of the pediatricians indicated that they had insufficient training to diagnose and treat maternal depression. The Parental Well-being Project of Dartmouth Medical School, which included 6 community pediatric practices in New Hampshire and Vermont, showed that pediatricians, using a simple 2-question screen, could effectively screen for perinatal depression. In the 6 months of the pilot, screening was performed at 67% of well-child visits.

As with other screening (developmental and behavioral, psychosocial) initiatives in practice, there have been perceived barriers to implementation, including lack of time, incomplete training to diagnose/counsel, lack of adequate mental health referral sources, fear that screening means ownership of the problem, and lack of reimbursement.36 However, since 2000, there have been many successful models of screening in primary care practices, including developmental and behavioral screening, maternal depression screening, and psychosocial screening. In these projects, strategies have been implemented to integrate screening into office flow, to improve reimbursement, and to assist practices with identifying and collaborating with community resources, including mental health resources.37 The ABCD (Assuring Better Child Health and Development) Project, funded by the Commonwealth Fund and administered by the National Academy for State Health Policy, now involves 28 states and their AAP chapters. The Medicaid agency in Illinois, one of the ABCD states, pays pediatricians who use the Edinburgh Postpartum Depression Scale. Details of the various state initiatives and practice and parent materials are available at www.abcdresources.org and www.nashp.org. Heneghan et al,38 in their discussion of factors associated with management of maternal depression by pediatricians, reported that in their sample, 511 of 662 pediatricians reported identifying maternal depression and addressing it in practice. They discussed the practice characteristics and attitudes related to this and the need for changes in attitude and practice to improve identification and management. In their article about the legal and ethical considerations of postpartum depression screening at well-child visits, Chaudron et al concluded: “We believe that from the perspective of feasibility, and now from the legal and ethical standpoints, the benefits of screening outweigh the risks.”39

The primary care provider (PCP) has a particularly important role in the early identification of maternal depression and facilitation of intervention to prevent adverse outcomes for the infant, the mother, and the family. The PCP may be the first clinician to see the infant and mother after the infant is born; therefore, the PCP has very early access. In addition, it is the PCP who has continuity with the infant and family, and by the nature of this relationship, the PCP practices with a family perspective.

Screening for postpartum depression does not require that the PCP treat the mother. The infant is the PCP's patient. However, the PCP has a role in supporting the mother and facilitating her access to resources to optimize the child's healthy development and the healthy functioning of the family. For the mother, the infant's PCP provides information for family support, therapy resources, and/or emergency services as indicated. The PCP does provide guidance, support, referrals, and follow-up for the infant and the dyad relationship.

IMPLEMENTATION

Over the course of routine well-child care, the PCP and the family are developing a longitudinal relationship. Communication at each visit is tailored to the developmental process for the child and for the family. Anticipatory guidance addresses this dynamic developmental process. A crucial part of this communication is eliciting parent/family/child strengths and risks. Both parental and provider concerns determine the anticipatory guidance discussion.

Screening and surveillance for risk and protective factors are an integral part of routine care and the relationship with the child and family. This communication includes discussion of family support systems and other psychosocial factors such as poverty, parental mental health, and substance use. It begins as early as the prenatal visit. According to a recent AAP statement, a prenatal visit allows for getting to know the parent(s) and is an opportunity to identify any high-risk conditions to anticipate special care needs.40 In this statement, the AAP also recommended that pediatricians communicate with obstetricians in their community to inform them of their prenatal visit policies so that obstetricians might refer patients for the prenatal visit. This would also provide an opportunity for the pediatrician to become aware of depression during the pregnancy and to plan for support and follow-up of the mother-infant relationship. Perinatal/postpartum depression is an early risk to the infant, to the mother-infant bond, and to the family unit. Surveillance and screening for perinatal/postpartum depression is part of family-centered well-child care. Including postpartum depression screening in the practice's preventive services prompting system can help ensure a reliable process for addressing risk.

The new Bright Futures guidelines include surveillance regarding parental social-emotional well-being. The US Preventive Services Task Force has endorsed the Edinburgh Postnatal Depression Scale as well as the general 2-question screen for depression.2,41 Given the peak times for postpartum depression specifically, the Edinburgh scale would be appropriately integrated at the 1-, 2-, 4-, and 6-month visits. The Current Procedural Terminology (CPT) code 99420 is recommended for this screening, recognizing the Edinburgh scale as a measure for risk in the infant's environment, to be appropriately billed at the infant's visit.

The Edinburgh Postpartum Depression Scale is a simple, 10-question screen that is completed by the mother. A score of ≥10 indicates risk that depression is present. An affirmative response on question 10 (suicidality indicator) also constitutes a positive screen result. The screen is in the public domain and is freely downloadable. It is available in English and Spanish.

The 2-question screen for depression41 is:

Over the past 2 weeks:

  1. Have you ever felt down, depressed, or hopeless?

  2. Have you felt little interest or pleasure in doing things?

One yes answer is a positive screening result. This screen is suitable to indicate risk of depression for adults in general and is not specific to postpartum depression. Beyond the postpartum period, incorporating surveillance for parental mental health is warranted as well and might be accomplished by use of this 2-question screen.

Responses to a positive postpartum depression screening result range from reassurance (maternity blues) to supportive strategies (maternity blues, minor depression) and referral for specific interventions (minor and major depression). In the situation of milder symptoms, demystification and parent education may be effective in addressing concerns. Demystification lets the mother know that (1) she is not alone (postpartum depression happens to many women to varying degrees), (2) she is not to blame (hormonal changes play a big role), and (3) she will get better. Provision of extra return visits for support may be all the family needs and can build a strong foundation for the ongoing relationship between physician and family. Given the association with cessation of breastfeeding, particular promotion and encouragement of breastfeeding is indicated. When concerns are significant enough to warrant referral, there are several options and considerations. For the mother, particularly if the depression is more than mild, referral for therapy and/or medication may be needed. In some models, mothers have been referred to their obstetricians for follow-up; in others, mothers have been referred to mental health providers or their PCPs. It is important for pediatricians to communicate with the mothers' obstetricians and/or PCPs when these situations arise, because the obstetricians/PCPs will want to know about the mother's depression and may have a better understanding of the mental health system for adults. When the mother needs specific follow-up for herself, there are often access issues because of uninsured or underinsured status. Community mental health programs may also provide limited services for these mothers. Care for the mother is an advocacy issue for all who serve children and their families, and it is an issue for state AAP chapters to address in states where access for mothers is limited because of state policy and service and payment structure.

If suicidality or psychosis is a concern, or the score on the Edinburgh scale is greater than 20, accessing crisis intervention services for the mother is necessary. In this instance and for other mental health emergencies, the practice should know and use the referral process for local public mental health crisis/emergency services.

Treatment must address the mother-child dyad relationship. For the child and mother together, there are generally more referral options. If the child is in an environment of maternal depression, he or she is at risk for attachment issues, failure to thrive, abuse/neglect, and, ultimately, developmental delay. At the very least, close follow-up of the child in the medical home is warranted. Specific screening for social-emotional development, as well as for general development and behavior, should be included. Pilowsky et al, in the STAR*D–Child (Sequenced Treatment Alternatives to Relieve Depression–Child) study described above, recommended that children of depressed mothers be followed and assessed.42,43 The infant (with the mother) can be referred to a mental health clinician (with expertise for treatment of very young children) to address the dyad relationship. (Note that, depending on the family situation, this referral might be for the father or both parents.) For women with mild symptoms who need support, it may be enough to refer them to a parent support organization.

There are research-based programs for treatment of the dyad to promote healthy attachment and relationship. These programs include the Circle of Security, parent-child interactive therapy, and child-parent psychotherapy.44,45 The Circle of Security is a parent education and psychotherapy program. It is an individualized video-based intervention based on attachment theory to strengthen the parents' ability to observe and improve their caregiving capacity. Child-parent psychotherapy is a therapeutic treatment for mothers and young children to increase attachment security.45

Referral to early intervention (Part C of the Individuals With Disabilities Education Act) services can provide general developmental intervention (education), which, if performed in the home, also provides mentoring for healthy interaction. If the infant exhibits specific delays, specific therapies can also be provided. (To identify lead agencies and contacts according to state, see www.nectac.org and www.nichcy.org.)

For many families, referral to Early Head Start, Mother's Morning Out programs, or child care is an effective option as well. Mothers may receive services through Healthy Families America, a Nurse-Family Partnership (if the referral occurs prenatally), other evidence-based home-visiting programs, or local volunteer organizations. (To locate Head Start programs, see http://eclkc.ohs.acf.hhs.gov/hslc/HeadStartOffices.)

Whatever the treatment and referral options implemented, follow-up of the infant and mother by the PCP (to monitor progress and to support the family) is necessary.

The AAP Task Force on Mental Health and the Committee on the Psychosocial Aspects of Child and Family Health have promoted collaborative, colocated, and integrated models for mental health services within primary care medical homes. In such settings, social work staff or mental health providers, who are colocated in the practice as part of the care team, can provide immediate triage for positive screening results, support and follow-up for mothers, and linkage and referral for more specialized services. Colocated and integrated mental health providers can perform secondary screenings and collaborate with the PCP for ongoing care.

Concurrent with the implementation of screening, the practice needs to identify support and intervention resources, both within the practice and in the community. Although it is often the case that PCPs do not perceive that there are resources in the community, many public and private resources may be discovered in the process of engaging community partners. Networking with community providers may be a new activity for a primary care practice. It can be accomplished by invitation to a lunch meeting at the practice to discuss the planned screening and referral activities, or a larger meeting called by a group of practices may be possible. Sending out a brief inquiry or survey to local mental health providers or family support groups may yield additional contacts. Partnering with parents in finding community resources is the essence of the medical home.

MODELS AND RESOURCES

  • Virginia Bright Futures has a training Web site and has developed a new parent kit that includes information on perinatal depression and is given to 70% of new parents. Virginia Bright Futures partnered with the Virginia chapter of the AAP, the state Early Periodic Screening, Diagnosis, and Treatment (EPSDT), Resource Mothers, and Healthy Families Virginia47 and recommends adopting perinatal depression screening guidelines in the state budget.

  • Parental Depression Screening for Pediatric Clinicians: An Implementation Manual, by Ardis Olson, MD (available on the Commonwealth Fund Web site at (www.cmwf.org): In her studies, Olson has found that a 2-question paper-based screen, followed by a brief discussion with the mother and the pediatrician, was both feasible and effective in identifying women who needed follow-ups or referrals. One of the studies examined the difference between a verbal interview and a paper form; the paper screen was found to be far more effective.35,47,48

  • Depression During and After Pregnancy: A Resource for Women, Their Families, and Friends (www.mchb.hrsa.gov/pregnancyandbeyond/depression): This Web site has information for the woman and/or her family about the definition and symptoms of postpartum depression and when to seek treatment.

  • National Center for Children in Poverty, Project Thrive (www.nccp.org): The Public Policy Analysis and Education Center for Infants and Young Children at the National Center for Children in Poverty has as its core mission increasing knowledge and providing policy analysis that will help states build and strengthen comprehensive early childhood systems and link policies to ensure access to high-quality health care, early care and learning, and family support. The National Center for Children in Poverty has a document entitled “Reducing Maternal Depression and Its Impact on Young Children” (January 2008) that is an excellent source for pediatricians and AAP state chapters.

  • Bright Futures (http://brightfutures.aap.org).

  • The American College of Obstetricians and Gynecologists recommends psychosocial screening of pregnant women at least once per trimester (or 3 times during prenatal care) by using a simple 2-question screen and further screening if the preliminary screen result indicates possible depression.49

  • The National Women's Health Information Center (www.4women.gov) is a federal government source for women's health information.

SUMMARY AND CONCLUSIONS

The primary care pediatrician, by virtue of having a longitudinal relationship with families, has a unique opportunity to identify maternal depression and help prevent untoward developmental and mental health outcomes for the infant and family. Screening can be integrated, as recommended by Bright Futures and the AAP Mental Health Task Force, into the well-child care schedule and included in the prenatal visit. This screening has proven successful in practice in several initiatives and locations and is a best practice for PCPs caring for infants and their families. Intervention and referral are optimized by collaborative relationships with community resources and/or by colocated/integrated primary care and mental health practices.

LEAD AUTHOR

Marian F. Earls, MD

COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, 2009–2010

Benjamin S. Siegel, MD, Chairperson

Mary I. Dobbins, MD

Marian F. Earls, MD

Andrew S. Garner, MD

Laura McGuinn, MD

John Pascoe, MD

David L. Wood, MD

LIAISONS

Robert T. Brown, PhD

Society of Pediatric Psychology

Mary Jo Kupst, PhD

Society of Pediatric Psychology

D. Richard Martini, MD

American Academy of Child and Adolescent Psychiatry

Mary Sheppard, MS, RN, PNP, BC

National Association of Pediatric Nurse Practitioners

CONSULTANT

George J. Cohen, MD

STAFF

Karen S. Smith

ksmith{at}aap.org

Footnotes

  • The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

  • This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

  • All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed,revised, or retired at or before that time.

  • AAP =
    American Academy of Pediatrics •
    PCP =
    primary care provider

REFERENCES

  1. 1.↵
    1. Isaacs M
    . Community Care Networks for Depression in Low-Income Communities and Communities of Color: A Review of the Literature. Washington, DC: Howard University School of Social Work and the National Alliance of Multiethnic Behavioral Health Associations; 2004
  2. 2.↵
    1. Kahn RS,
    2. Wise PH,
    3. Wilson K
    . Maternal smoking, drinking and depression: a generational link between socioeconomic status and child behavior problems [abstract]. Pediatr Res. 2002;51(pt 2):191A
    OpenUrl
  3. 3.↵
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Washington, DC: American Psychiatric Association; 1994
  4. 4.↵
    1. Isaacs MR
    . Maternal Depression: The Silent Epidemic in Poor Communities. Baltimore, MD: Annie E. Casey Foundation; 2006
  5. 5.↵
    1. Goodman JH
    . Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. J Adv Nurs. 2004;45(1):26–35
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Ramchandani P,
    2. Stein A,
    3. Evans J,
    4. O'Connor TG
    ; ALSPAC Study Team. Paternal depression in the postnatal period and child development: a prospective population study. Lancet. 2005;365(9478):2201–2205
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Kahn RS,
    2. Brandt D,
    3. Whitaker RC
    . Combined effect of mothers' and fathers' mental health symptoms on children's behavioral and emotional well-being. Arch Pediatr Adolesc Med. 2004;158(8):721–729
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Chang JJ,
    2. Halpern CT,
    3. Kaufman JS
    . Maternal depressive symptoms, father's involvement, and the trajectories of child problem behaviors in a US national sample. Arch Pediatr Adolesc Med. 2007;161(7):697–703
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Mezulis AH,
    2. Hyde JS,
    3. Clark R
    . Father involvement moderates the effect of maternal depression during a child's infancy on child behavior problems in kindergarten. J Fam Psychol. 2004;18(4):575–588
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. McLennan JD,
    2. Kotelchuck M
    . Parental prevention practices for young children in the context of maternal depression. Pediatrics. 2000;105(5):1090–1095
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    1. Chung EK,
    2. McCollum KF,
    3. Elo IT,
    4. Lee HJ,
    5. Culhane JF
    . Maternal depressive symptoms and infant health practices among low-income women. Pediatrics. 2004;113(6). Available at: www.pediatrics.org/cgi/content/full/113/6/e523
  12. 12.↵
    1. Kavanaugh M,
    2. Halterman JS,
    3. Montes G,
    4. Epstein M,
    5. Hightower AD,
    6. Weitzman M
    . Maternal depressive symptoms are adversely associated with prevention practices and parenting behaviors for preschool children. Ambul Pediatr. 2006;6(1):32–37
    OpenUrlCrossRefPubMed
  13. 13.↵
    1. Paulson JF,
    2. Dauber S,
    3. Leiferman JA
    . Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics. 2006;118(2):659–668
    OpenUrlAbstract/FREE Full Text
  14. 14.↵
    1. Sills MR,
    2. Shetterly S,
    3. Xu S,
    4. Magid D,
    5. Kempe A
    . Association between parental depression and children's health care use. Pediatrics. 2007;119(4):829–836
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    1. DeBellis MD,
    2. Thomas LA
    . Biologic findings of post-traumatic stress disorder and child maltreatment. Curr Psychiatry Rep. 2003;5(2):108–117
    OpenUrlCrossRefPubMed
  16. 16.↵
    1. Hagele DM
    . The impact of maltreatment on the developing child. N C Med J. 2005;66(5):356–359
    OpenUrlPubMed
  17. 17.↵
    1. Riley AW,
    2. Brotman M
    . The Effects of Maternal Depression on the School Readiness of Low-Income Children. Baltimore, MD: Annie E. Casey Foundation, Johns Hopkins Bloomberg School of Public Health; 2003
  18. 18.↵
    1. Trapolini T,
    2. McMahon CA,
    3. Ungerer JA
    . The effect of maternal depression and marital adjustment on young children's internalizing and externalizing behavior problems. Child Care Health Dev. 2007;33(6):794–803
    OpenUrlCrossRefPubMed
  19. 19.↵
    Agency for Healthcare Research and Quality. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality; 2007:130–131. Evidence Report 153
  20. 20.↵
    Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. NICHD Early Child Care Research Network. Dev Psychol. 1999;35(5):1297–1310
    OpenUrlCrossRefPubMed
  21. 21.↵
    Zero to Three. Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: DC0-3R. Washington, DC: Zero to Three; 2005
  22. 22.↵
    1. Essex MJ,
    2. Klein MH,
    3. Cho E,
    4. Kalin NH
    . Maternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior. Biol Psychiatry. 2002;52(8):776–784
    OpenUrlCrossRefPubMed
  23. 23.↵
    1. Shaw DS,
    2. Connell A,
    3. Dishion TJ,
    4. Wilson MN,
    5. Gardner F
    . Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior. Dev Psychopathol. 2009;21(2):417–439
    OpenUrlCrossRefPubMed
  24. 24.↵
    1. Pilowsky DJ,
    2. Wickramaratne P,
    3. Talati A,
    4. et al
    . Children of depressed mothers 1 year after the initiation of maternal treatment: findings from the STAR*D–Child Study. Am J Psychiatry. 2008;165(9):1136–1147
    OpenUrlCrossRefPubMed
  25. 25.↵
    1. Foster CE,
    2. Webster MC,
    3. Weissman MM,
    4. et al
    . Remission of maternal depression: relations to family functioning and youth internalizing and externalizing symptoms. J Clin Child Adolesc Psychol. 2008;37(4):714–724
    OpenUrlCrossRefPubMed
  26. 26.↵
    US Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Washington, DC: US Public Health Service; 1999
  27. 27.↵
    US Public Health Service. Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington, DC: US Department of Health and Human Services, 2000
  28. 28.↵
    1. Hagan JF Jr.,
    2. Shaw JS,
    3. Duncan P
    , eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2008
  29. 29.↵
    1. Siegel BS,
    2. Foy JM
    ; American Academy of Pediatrics, Committee on the Psychosocial Aspects of Child and Family Health, Task Force on Mental Health. The future of pediatrics: mental health competencies for pediatric primary care. Pediatrics. 2009;124(1):410–421
    OpenUrlAbstract/FREE Full Text
  30. 30.↵
    American Academy of Pediatrics, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. The medical home. Pediatrics. 2002;110(1 pt 1):184–186
    OpenUrlAbstract/FREE Full Text
  31. 31.↵
    1. Schor EL
    ; American Academy of Pediatrics, Task Force on the Family. Family pediatrics: report of the task force on the family. Pediatrics. 2003;111(6 pt 2):1541–1571
    OpenUrl
  32. 32.↵
    Substance Abuse and Mental Health Services Administration. Final Report for the President's New Freedom Commission on Mental Health. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2003. SMA 03–3832
  33. 33.↵
    1. Minkovitz CS,
    2. Strobino D,
    3. Scharfstein D,
    4. et al
    . Maternal depressive symptoms and children's receipt of health care in the first 3 years of life. Pediatrics. 2005;115(2):306–314
    OpenUrlAbstract/FREE Full Text
  34. 34.↵
    1. Olson AL,
    2. Kemper KJ,
    3. Kelleher KJ,
    4. Hammond CS,
    5. Zuckerman BS,
    6. Dietrich AJ
    . Primary care pediatricians' roles and perceived responsibilities in the identification and management of maternal depression. Pediatrics. 2002;110(6):1169–1176
    OpenUrlAbstract/FREE Full Text
  35. 35.↵
    1. Olson A,
    2. Dietrich AJ,
    3. Prazar G,
    4. Hurley J
    . Brief maternal depression screening at well-child visits. Pediatrics. 2006;118(1):207–216
    OpenUrlAbstract/FREE Full Text
  36. 36.↵
    1. Heneghan AM,
    2. Silver EJ,
    3. Bauman LJ,
    4. Stein REK
    . Do pediatricians recognize mothers with depressive symptoms?Pediatrics. 2000;106(6):1367–1373
    OpenUrlAbstract/FREE Full Text
  37. 37.↵
    1. Earls MF,
    2. Hays SS
    . Setting the stage for success: implementation of developmental and behavioral screening and surveillance in primary care practice: the North Carolina ABCD Project. Pediatrics. 2006;118(1). Available at: www.pediatrics.org/cgi/content/full/118/1/e183
  38. 38.↵
    1. Heneghan AM,
    2. Chaudron LH,
    3. Storfer-Isser A,
    4. et al
    . Factors associated with identification and management of maternal depression by pediatricians. Pediatrics. 2007;119(3):444–454
    OpenUrlAbstract/FREE Full Text
  39. 39.↵
    1. Chaudron LH,
    2. Szilagyi PG,
    3. Campbell AT,
    4. Mounts KO,
    5. McInerny TK
    . Legal and ethical considerations: risks and benefits of postpartum depression screening at well-visits. Pediatrics. 2007;119(1):123–128
    OpenUrlAbstract/FREE Full Text
  40. 40.↵
    1. Cohen GJ
    ; American Academy of Pediatrics, Committee on the Psychosocial Aspects of Child and Family Health. The prenatal visit. Pediatrics. 2009;124(4):1227–1232
    OpenUrlAbstract/FREE Full Text
  41. 41.↵
    US Preventive Services Task Force. Screening for depression: recommendations and rationale. Ann Intern Med. 2002;136(10):760–764
    OpenUrlCrossRefPubMed
  42. 42.↵
    1. Pilowsky DJ,
    2. Wickramaratne PJ,
    3. Rush AJ,
    4. et al
    . Children of currently depressed mothers: a STAR*D ancillary study. J Clin Psychiatry. 2006;67(1):126–136
    OpenUrlCrossRefPubMed
  43. 43.↵
    1. Weissman MM,
    2. Pilowsky DJ,
    3. Wickramaratne PJ,
    4. et al.
    ; STAR*D–Child Team. Remissions in maternal depression and child psychopathology: a STAR*D–child report [published correction appears in JAMA. 2006;296 (10):1234]. JAMA. 2006;295(12):1389–1398
    OpenUrlCrossRefPubMed
  44. 44.↵
    1. Appleyard K,
    2. Berlin L
    . Supporting Healthy Relationships Between Young Children and Their Parents: Lessons From Attachment Theory and Research [brief]. Durham, NC: Duke University Center for Child and Family Policy; 2007
  45. 45.↵
    1. Cassidy J,
    2. Shaver PR
    1. Berlin L,
    2. Zeanah CH,
    3. Lieberman AF
    . Prevention and intervention programs for supporting early attachment security. In: Cassidy J, Shaver PR, eds. Handbook of Attachment. 2nd ed. New York, NY: Guilford Press; 2008:745–761
  46. 46.
    1. Gwimmer V,
    2. Zimmerman B
    . Virginia's Bright Futures Story. Alexandria, VA: Altarum Institute; 2006
  47. 47.↵
    1. Olson AL,
    2. Dietrich AJ,
    3. Prazar G,
    4. et al
    . Two approaches to maternal depression screening during well child visits. J Dev Behav Pediatr. 2005;26(3):169–176
    OpenUrlCrossRefPubMed
  48. 48.↵
    1. Knitzer J,
    2. Theberge S,
    3. Johnson K
    . Reducing Maternal Depression and Its Impact on Young Children: Toward a Responsive Early Childhood Policy Framework. New York, NY: National Center for Children in Poverty; 2008
  49. 49.↵
    American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women. ACOG committee opinion No. 343: psychosocial risk factors: perinatal screening and intervention. Obstet Gynecol. 2006;108(2):469
    OpenUrlCrossRefPubMed
  • Copyright © 2010 by the American Academy of Pediatrics
PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Pediatrics
Vol. 126, Issue 5
1 Nov 2010
  • Table of Contents
  • Index by author
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice
Marian F. Earls, The Committee on Psychosocial Aspects of Child and Family Health
Pediatrics Nov 2010, 126 (5) 1032-1039; DOI: 10.1542/peds.2010-2348

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice
Marian F. Earls, The Committee on Psychosocial Aspects of Child and Family Health
Pediatrics Nov 2010, 126 (5) 1032-1039; DOI: 10.1542/peds.2010-2348
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Abstract
    • BACKGROUND
    • THE IMPACT OF MATERNAL DEPRESSION ON THE INFANT
    • THE ROLE OF THE PRIMARY CARE PROVIDER
    • IMPLEMENTATION
    • MODELS AND RESOURCES
    • SUMMARY AND CONCLUSIONS
    • LEAD AUTHOR
    • COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, 2009–2010
    • LIAISONS
    • CONSULTANT
    • STAFF
    • Footnotes
    • REFERENCES
  • Info & Metrics
  • Comments

Related Articles

  • Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice
  • PubMed
  • Google Scholar

Cited By...

  • Amygdala-Prefrontal Structural Connectivity Mediates the Relationship between Prenatal Depression and Behavior in Preschool Boys
  • Family Values Means Covering Families: Parents Need to Focus on Parenting, Not Access to Care
  • Postpartum depression screening: are we doing a competent job?
  • Ongoing Pediatric Health Care for the Child Who Has Been Maltreated
  • Management of perinatal depression with non-drug interventions
  • Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice
  • Psychosocial Factors in Children and Youth With Special Health Care Needs and Their Families
  • Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice
  • The Role of Integrated Care in a Medical Home for Patients With a Fetal Alcohol Spectrum Disorder
  • The Prenatal Visit
  • Implementing Parental Tobacco Dependence Treatment Within Bronchiolitis QI Collaboratives
  • The Grief of Mothers After the Sudden Unexpected Death of Their Infants
  • Maternal Adverse Childhood Experiences and Infant Development
  • Universal Screening for Perinatal Depression
  • Outcomes of Universal Perinatal Mood Screening in the Obstetric and Pediatric Setting
  • Postpartum Depression: What Do Pediatricians Need to Know?
  • An Autoethnographic Examination of Postpartum Depression
  • Peripartum depression: Early recognition improves outcomes
  • Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting
  • Telephone delivery of interpersonal psychotherapy by certified nurse-midwives may help reduce symptoms of postpartum depression
  • Interconception Care for Mothers During Well-Child Visits With Family Physicians: An IMPLICIT Network Study
  • Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care
  • Uncovering the Golden Veil: Applying the Evidence for Telephone Screening to Detect Early Postpartum Depression
  • Child Health Disparities: What Can a Clinician Do?
  • Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses
  • Repeated Depression Screening During the First Postpartum Year
  • Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT
  • Accuracy of Brief Screening Tools for Identifying Postpartum Depression Among Adolescent Mothers
  • Child Exposure to Parental Violence and Psychological Distress Associated With Delayed Milestones
  • Enhancing Home Visiting With Mental Health Consultation
  • Postpartum Anxiety and Maternal-Infant Health Outcomes
  • The Lifelong Effects of Early Childhood Adversity and Toxic Stress
  • Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health
  • Maternal Perinatal Depression in the Neonatal Intensive Care Unit: The Role of the Neonatal Nurse
  • Pediatrician's role * Each year, 400,000 infants are born to depressed mothers. How you can help.
  • Google Scholar

More in this TOC Section

  • AAP Publications Reaffirmed or Retired
  • Caring for American Indian and Alaska Native Children and Adolescents
  • Recommended Childhood and Adolescent Immunization Schedule: United States, 2021
Show more From the American Academy of Pediatrics

Similar Articles

Subjects

  • Fetus/Newborn Infant
    • Fetus/Newborn Infant
  • Current Policy
  • Journal Info
  • Editorial Board
  • Editorial Policies
  • Overview
  • Licensing Information
  • Authors/Reviewers
  • Author Guidelines
  • Submit My Manuscript
  • Open Access
  • Reviewer Guidelines
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • AAP.org
  • shopAAP
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
  • RSS
American Academy of Pediatrics

© 2021 American Academy of Pediatrics