Pediatricians are in a unique position to identify and intervene when postpartum depression (PPD) symptoms appear in new moms. At a time when awareness of mental health issues is increasing and any associated stigma is decreasing, taking time to address this with new mothers is essential. Although many pediatricians do weave postpartum depression screenings into their visits, this condition is still overlooked in too many practices. U.S. News & World Report states that,
“Ten to 20 percent of the approximately 4 million women who give birth each year in the U.S. experience postpartum depression… Yet research shows that fewer than half of all affected mothers receive a mental health diagnosis, and only 15% of those who do receive a diagnosis seek mental health services.”
And according to MD Edge,
“The incidence of depression in the first 3 months postpartum is estimated at about 14%, and the consequences can be severe. A new mom with a mood disorder in the first year of her child’s life can disrupt the mother-infant relationship, thereby contributing to both short- and long-term adverse outcomes for the child. These include behavior problems, low self-esteem, poor self-regulation, and an increased risk of impaired mental and motor development.”
Despite these facts, “postpartum depression is both under-recognized and undertreated.” The article goes on to discuss the results of a study where “about one in 4 (26%) of the 674 mothers who had positive screens were not asked about their emotional state by their clinicians.” That said, screening alone is often not enough. It is important that pediatricians have followup conversations with women whose screening results are positive for PPD.
What is Postpartum Depression?
Postpartum depression is a condition that affects some women in the months after giving birth. According to the American Academy of Pediatricians (AAP),
“PPD affects 10-25% of mothers, making it the most common underdiagnosed obstetric complication. Nationally, it is estimated that every year, more than 400,000 infants are born to mothers who are depressed.”
The depression some women can experience after having a baby falls into 3 categories: postpartum blues, postpartum depression, and postpartum psychosis. Each category has symptoms with varying degrees of intensity. According to the American Psychological Association (APA),
“It’s common for women to experience the “baby blues” — feeling stressed, sad, anxious, lonely, tired or weepy — following their baby’s birth. But some women, up to 1 in 7, experience a much more serious mood disorder — postpartum depression. (Postpartum psychosis, a condition that may involve psychotic symptoms like delusions or hallucinations, is a different disorder and is very rare.) Unlike the baby blues, PPD doesn’t go away on its own. It can appear days or even months after delivering a baby; it can last for many weeks or months if left untreated.”
A 2016 article published in the Maternal and Child Health Journal says,
“Postpartum depression is associated with impaired bonding and development, marital discord, suicide, and infanticide. However, the current standard of care is to not screen women for postpartum depression.”
Despite this, the AAP states that,
“Although pediatricians are aware of this condition, it may not be the foremost thought in their minds at the well-child visit. However, pediatricians have the greatest opportunity of encountering the infant and caregivers regularly. Therefore, we have a responsibility to screen mothers for PPD and offer the most appropriate resources.”
Screening for Postpartum Depression
One of the most effective things pediatricians can do to help is to include postpartum depression screening and surveillance at routine well-baby visits. According to U.S. News & World Report,
“Screening for postpartum depression in pediatric settings is gaining national attention as an increasing volume of research underscores the importance of healthy mother-baby relationships to an infant’s brain development. AAP recommends universal surveillance and screening of postpartum depression by pediatric care providers, and national health quality measures now include maternal depression screening.”
The article also states that pediatricians are in a prime position to do screenings since new mothers typically visit their offices for well-baby checks at least half a dozen times in the first six months after the baby is born – commonly the timeframe when PPD symptoms are most likely to appear.
What Screening Tools Should Pediatricians Use for PPD?
Many pediatricians use the Edinburgh Postnatal Depression Scale (EDPS). Typically, this 10-question screening tool will be filled out by new moms at 2-4 weeks post-birth as well as at the 2, 4, and 6-month marks.
One of the best things a pediatrician can do is to have an in-depth conversation with a new mom. Often, new moms may appear to be just fine on the surface, but a more detailed conversation can reveal symptoms of PPD. According to parents.com, some of the questions a pediatrician can ask a new mom include:
- Are you feeling especially sad or down lately?
- Are you feeling particularly anxious?
- Do you have recurrent thoughts or fears around the baby?
- Do you have trouble falling or staying asleep?
- Have you lost interest in eating, or are you eating constantly?
- Do you have trouble concentrating?
- Do you think about harming yourself or your baby?
- Do you have a history of depression?
- Have these symptoms been going on for longer than 2 weeks?
Postpartum Progress shares some of the reasons pediatricians cite for not engaging in these screenings and/or conversations. They include:
- lack of time
- not enough education around PPD
- lack of confidence addressing mental health issues
- not reimbursed well enough
- lack of resources to refer to
- fear of liability
When asked what she would say to a pediatrician who does not yet provide PPD screenings, PCC’s client Dr. Vineetha Alias from Watchung Pediatrics in New Jersey says:
“Initially when starting the screening process in our office, there were several concerns about how time consuming it would be and if it was really necessary. However, we’ve realized that addressing any depression issues with mom early on is greatly beneficial to the child. It prevents other issues down the road that are more cumbersome to deal with than a quick screening tool in the office.”
What Else Can Pediatricians Do for Postpartum Depression?
In addition to routine screening, pediatricians can:
- have informational handouts about PPD available at the practice
- make referrals to mental health counselors or back to the mom’s OB-GYN
- educate new moms about what symptoms to lookout for in themselves
Can Pediatricians Get Paid for Postpartum Depression Screenings?
Whether or not a pediatrician gets paid for providing PPD screenings is largely payer and/or state-specific. Private payers may or may not cover this service, and at varying rates. As for Medicaid, according to the AAP, “State Medicaid agencies may cover maternal depression screening as part of a well-child visit. In addition to screenings, states must also cover any medically necessary treatment for the child as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Additionally, treatment for maternal depression that includes both the child and the parent, such as family counseling, may also be paid for under EPSDT. While Medicaid programs are permitted to pay for these services, states must affirmatively act to implement coverage. States also have discretion regarding the procedures used to pay pediatricians for providing maternal depression screening services. States are permitted to require that a specific screening tool be used in order to pediatricians to be paid. They can also limit the number of screenings allowed.”
Whether or not they get paid for PPD screenings, many pediatricians choose to provide this care for new moms. As PCC client Dr. Kevin Wessinger of the South Carolina Pediatric Alliance says,
“It [PPD screening] is quick and easy to do, improves care for the baby, and generates a little bit of revenue for the practice… a win/win/win.”
Pediatricians commonly use the CPT code 96161 (often with a -59 modifier) to bill for PPD screening. The AAP states that 96161 is “Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument. Code 96161 can be reported for a postpartum screening administered to a mother as part of a routine newborn check but billed under the baby’s name.”
How a Pediatric-Focused EHR Can Help
When a pediatrician uses an EHR built specifically for their branch of medicine, it becomes very easy to incorporate PPD screenings into a well-visit. For example, PCC’s EHR has the capability to build an order for the Edinburgh Postnatal Depression Scale (EDPS) Screening Tool right into a well-visit protocol. Results from the screening can be entered right into the chart. And with that, PPD screening can easily and seamlessly become a routine part of newborn well-visits.
We are at a critical time for the recognition and treatment of postpartum depression. Research shows more and more that PPD impacts more than just the new mom; there can also be consequences for the child’s brain development. With a pediatric-focused EHR, pediatricians can easily incorporate these important screens. It’s good for patients, families, and the practice. Again quoting Dr. Alias on this,
“Everyone dotes on a mother while she is pregnant, but then focuses on the baby after he/she is born. They forget that this woman has just gone through a major life event that has taken a toll on her health, physical appearance, hormones, career, relationships, etc. We need to factor that into our care of the newborn as it directly impacts the child.”