Report: Pediatricians can play crucial role

Pediatricians can play a key role in helping to identify mental health issues in new mothers, according to a report released by the Child Health and Development Institute (CHDI) of Connecticut.

Barbara Ward-Zimmerman, Ph.D., licensed child psychologist, behavioral health and primary care integration consultant and one of the authors of the report, “Addressing Maternal Mental Health in the Pediatric Medical Home” said OB/GYNs should also be screening for mental health issues at regular intervals. She said it also makes sense for pediatricians to play a role in identifying challenges that new moms are facing.

“The earlier we identify (challenges), the better,” Ward-Zimmerman said. “The first post-delivery visit for an OB/GYN appointment typically is at six weeks and many mothers – especially those who are depressed – do not keep that appointment unless there’s something in particular going on.”

However, newborns and their mothers visit pediatric providers routinely in the baby’s first year of life (typically six times within the first six months) and more often than they see any other health care provider, according to the report.

So truly, it is the pediatrician who sees the mom on a regular basis during the first months of a baby’s life,” Ward-Zimmerman said.

“The beauty of the pediatrician’s office in addressing this whole area is that it is normalizing,” Ward-Zimmerman said. She referenced one pediatric practice in Connecticut that developed an informational brochure that is handed to all new mothers during the first well-child visit after delivery.

“By giving all new moms this information, it really gives that strong message of – if you do (struggle with mental health issues), it’s part of life and we’re here to help you with it.”

Pediatricians can use very brief screening tools – some versions have as few as two questions; one of the more commonly used tools – the Edinburgh Postnatal Depression Scale – has 10. Ward-Zimmerman said typically, questionnaires are administered by the front office staff during check-in and reviewed by a nurse or medical assistant before being turned over to the pediatrician.

Maternal anxiety and/or depressive disorders can result in developmental difficulties or delays for children including neurological development, according to the report.

“Every area of development is impacted by the lack of appropriate interaction and bonding,” Ward-Zimmerman said.

“The role of pediatrics is prevention in the first place; that’s what they do really well,” Ward-Zimmerman said. “That’s what’s exciting about this particular area. You can have an impact. This is one thing that we absolutely can identify and it’s treatable and it can make a difference.”

Ward-Zimmerman said some women develop symptoms during pregnancy, so screening at or pre-delivery can be helpful.

“During pregnancy, there’s research that shows social support helps moms stay on better track, emotionally,” so by determining a woman at risk, the right interventions and supports can take place.

In Connecticut, the CHDI provides outreach and free maternal mental health screening training to medical providers and reimbursement for formal screening is now available for medical providers in that state.

Ward-Zimmerman said psychologists with expertise in this area can be helpful in working with primary care offices to develop screening programs and in helping ensure connections to the proper resources for pediatricians.

“We can’t ask the pediatrician to screen unless they have good referral resources,” she said, noting that one effort to increase this communication is a planned March conference on post-partum support.