Although asking about maternal depression increased among pediatricians by about 30 percent between 2004 and 2013, less than half of pediatricians usually screen for the condition. According to researchers from the Children’s Hospital at Montefiore (CHAM), NYU Langone Medical Center and the Nathan Kline Institute for Psychiatric Research, this represents a missed opportunity to identify depression and provide women appropriate treatment. The findings of this study are in the current issue of the Journal of Developmental & Behavioral Pediatrics.

Maternal depression affects up to 40 percent of mothers with young children and can have many negative effects on the infant and developing child including feeding issues, the ability to thrive in relationships and poor cognitive health.

“Maternal depression is often overlooked and untreated because women with mental health issues do not routinely access health care for themselves,” said Ruth E. K. Stein, M.D., co-author, attending physician, CHAM and professor of Pediatrics, Albert Einstein College of Medicine. “The pediatrician’s office is a frequently-visited venue for mothers, offering invaluable opportunities for pediatricians to identify the condition and connect moms with services that can help families thrive.”

Researchers analyzed data from the American Academy of Pediatrics Periodic Surveys. The most recent survey included 321 non-trainee, general practice pediatricians who answered questions about maternal mental health, access to services and training in mental health in 2013. Survey results were compared to a similar sample (457 pediatricians) who answered the same questions in 2004. Between 2004 and 2013 the percentage of pediatricians who usually asked about maternal depression increased from 33 to 44 percent.

The US Task Force for Preventive Services recently released updated guidelines specifically recommending screening for depression in pregnant and postpartum women.

“Our study demonstrates that screening by pediatricians has increased over the years, which is promising,” said Bonnie D. Kerker, PhD., lead author, associate professor, Department of Child and Adolescent Psychiatry, NYU Langone Medical Center’s Child Study Center, and Research Scientist, Nathan Kline Institute. “Not all pediatricians, however, think mental health or family health is within the scope of their practice. Given how much we know about parent characteristics as risk factors for poor child development, we need to place more emphasis on understanding the entire family context, so pediatricians can provide appropriate care for their patients.”

The researchers believe there are several barriers to screening and implementing services for families, including reimbursement policies that differ from state to state and which may not cover time spent talking to patients’ mothers about their mental health. Onsite, evidence-based screening and interventions for maternal depression are also not always accessible, prompting off-site referrals, which make it less likely that families get the treatment they need.

“Providers may be hesitant to screen if they don’t have feasible treatment options to offer their patients,” said Dr. Kerker. “While some women may need intensive mental health treatment, others may have mild symptoms that, if left untreated, could become more serious. Offering low-cost preventive interventions that can be implemented by broader teams of mental health providers could reduce symptoms and prevent severe depression among at-risk women.”

The study authors also believe that training the next generation of physicians in the importance of family health to children’s well-being would greatly benefit children and their families.

At Montefiore Health System robust efforts have been underway for more than a decade to integrate behavioral health services in pediatric primary care. Pediatricians, psychologists, psychiatrists and social workers collaborate closely to conduct preventive screenings, assessments, counseling, and interventions to improve outcomes for children and their caregivers.