Beyond screening: a review of pediatric primary care models to address maternal depression.
Depression is one of the most debilitating chronic disorders in the United States, affecting 15 million children in homes with depressed mothers, many of whom endure household chaos, inconsistent nurturing, inadequate safety practices, and harsh discipline. Depressed mothers are under diagnosed and undertreated, yet there is broad consensus about the importance of identifying and managing maternal depression, as reflected in recommendations by pediatric and obstetric professional organizations to routinely screen for perinatal depression. Screening was shown to be acceptable to women and most pediatric providers, and adding a screening component need not impair clinic efficiency. Screening, however, is not sufficient, and there are few models in the literature to guide medical practices in implementing successful interventions to identify, treat, and prevent maternal depression, particularly in the pediatric setting. We reviewed the literature and identified six studies that evaluated models for screening and managing mothers' depression in pediatric primary care settings. Some of these interventions have promise, but no studies characterized health outcomes of the depressed mothers and children. We discuss the components of these models, their implementation, and the practice and research needed to create effective pediatrics-based systems to reduce the negative effects of maternal depression on mothers, children, and families.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Nomi S
NS
Weiss-Laxer
Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Rheanna
R
Platt
Department of Psychiatry and Behavioral Sciences, Women's Mood Disorders Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Lauren M
LM
Osborne
Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.
Mary
M
Kimmel
Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Barry S
BS
Solomon
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Tamar
T
Mendelson
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Lindsey
L
Webb
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Anne W
AW
Riley
D002648:Child; D003863:Depression / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D017146:Models, Organizational; D010372:Pediatrics; D011247:Pregnancy