122 - Maternal postpartum depression screening, interventions, and outcomes in the pediatric clinic

The American Academy of Pediatrics (AAP) recommends screening for postpartum depression (PPD) at 1-, 2-, 4- and 6-month well child checks (WCC). However, little is known about the management and outcomes of mothers/infant dyad who screen positive for PPD in the outpatient setting.

Objective:

To assess pediatrician management of mothers screening positive for PPD, and to examine the associations between maternal PPD scores and infant developmental screening scores at 9- and 18-month WCC visits.

Design/Methods:

A retrospective chart review of all infants who attended a 1-, 2-, 4- and 6-month-old WCC visit at two pediatric clinics in a 6-month period. We included all infants whose mother screened positive on the Edinburgh Depression Scale (EPDS) defined as score ≥10. Descriptive statistics were used to summarize demographics, EPDS scores, and pediatrician management with PPD resources, referral to therapy, and follow up at 9- and 12-month WCC. Fisher’s exact test was used to analyze the correlation between maternal EPDS score and infant Ages and Stages (ASQ) developmental screening score at 9- and 18-month WCC.

Results:

Between Jan. 1 and June 30, 2018, 6.7% (73/1092) mothers screened positive for PPD. 47.9% infants were non-Hispanic White, 8.2% white Hispanic, 15% Asian/Pacific Islander, 9.6% Black, and 19.2% other; 47.9% had private, 34.2% Medicaid, and 17.8% Tricare insurance (Table 1). Pediatricians provided PPD resources to 67.1% (49/73), documented that 23.3% (17/73) mothers already had therapy care, and referred 11% (8/73) mother/infant dyads for therapy (Table 2). At the 9-month WCC, only 7.5% pediatricians documented follow up of PPD, and 0% documented follow up at 12-month WCC. There were no associations between maternal EPDS scores and infant ASQ scores at 9- and 18-month WCC (Table 3).

Conclusion(s):

Pediatricians followed the AAP maternal PPD screening guidelines and offered resources to mothers screening positive for PPD, but provided limited referrals to therapy and follow up. This highlights the need for more structured interventions and follow up of infants/mothers with PPD beyond the first 6 months of life. Though our study demonstrated no association between maternal PPD and infant ASQ scores, this is contrary to other studies that reported an association between childhood developmental delays and maternal PPD. Future studies should investigate this further with a larger sample size.