As many as one in five new mothers experience mental health challenges that impact their ability to care for their children, according to a report released this week by the Child Health and Development Institute (CHDI) of Connecticut. More of these instances would be diagnosed and treated if more pediatricians screened mothers at well-baby visits, the report states.
Doing so represents a culture shift among pediatricians, said Lisa Honigfeld, CHDI vice president of health initiatives.
“It’s a new way to look at child health services,” she said, but a worthwhile one. “This is a great opportunity.”
Pediatricians see firsthand how children are affected when mothers struggle with mental illness, Honigfeld said. Children in such circumstances can experience developmental delays and encounter their own mental challenges, she added.
“The implications of not addressing maternal mental health are lifelong,” she said. “It’s got to be addressed, and it’s got to be addressed early.”
Maternal mental health problems can arise during preconception, pregnancy, labor, delivery and the first year after giving birth.
The most common maternal mental health challenge mothers face is postpartum depression, according to the study. It affects 10 to 20 percent of mothers and typically begins six to eight weeks after giving birth.
Among low-income and teenage moms, rates of postpartum depression jump to 40 to 60 percent, according to the report.
Less common maternal mental illnesses – which are no less severe or debilitating – include postpartum anxiety (affecting 8.5 to 18 percent of new mothers), postpartum obsessive-compulsive disorder (affecting 3 percent), postpartum post-traumatic stress disorder (9 percent) and postpartum psychosis (0.1 to 0.2 percent), the study says.
A pediatrician is in the best position to assess a mother’s mental state because that doctor sees her so often, Honigfeld said.
After a woman gives birth, her obstetrician typically won’t see her until six weeks postpartum and likely not again until her next annual exam or pregnancy. Pediatricians, on the other hand, usually see mothers at six well-baby visits within the first six months after they give birth.
Plus, “it’s the pediatricians who really will be treating the kids going forward over the long haul,” addressing any potential effects the mother’s mental state has on her children, Honigfeld said.
The biggest barrier to screening at pediatricians’ offices, Honigfeld said, is time – there are so many things doctors already have to fit into a well-baby visit. Still, doctors in Connecticut are rising to the challenge.
“I have been astounded at how receptive pediatricians have been at implementing maternal depression screenings and connecting mothers to services,” she said. “They’ve embraced it.”
While some initially are hesitant because they fear screenings will be too time-consuming, many pediatricians have found quick and efficient ways to screen that they are incorporating into their workflow, she said.
The trend has the potential to have a big impact. While many mothers, in Connecticut and nationwide, struggle with maternal mental health issues, research shows less than half are diagnosed and just 15 percent seek professional help, according to the report. The CHDI says increased screening could lead to 30 percent more cases of depression being diagnosed.
The study found that many pediatricians feel it is important to address maternal mental health concerns but sometimes struggle with how best to do so.
A good place to start, according to the CHDI, is by asking about mothers’ mental health status during pregnancy. Depression and anxiety identified during pregnancy are a strong indicator that a mom may suffer from mental health issues after giving birth, making it important for pediatricians to know how a mother felt when she was pregnant, the report says.
The organization advocates for universal maternal mental health screening at well-baby visits and says many states, including Connecticut, are making strides toward that goal. In Connecticut, the CHDI provides outreach and free training to medical providers, and reimbursement for formal screening is now available for medical providers.
As a result, child health care providers billed for nearly 1,000 depression screenings for moms with children insured in the state’s Medicaid program in 2013, according to the report.
The CHDI is a subsidiary of the Children’s Fund of Connecticut, and is a nonprofit that promotes the healthy physical, behavioral, emotional, cognitive and social development of children in Connecticut.
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