New guidelines recommending depression screening during primary-care visits for pregnant women and new mothers, appropriately implemented, should benefit not only mothers but their children as well. The guidelines were issued last month by the U.S. Preventive Services Task Force.
Untreated depression can harm a mother's well-being and impair her ability to function as a parent. Children of depressed parents are more likely to experience social and emotional problems, delays in cognitive and social development, and long-term behavioral problems. In turn, a child's developmental delays can heighten family stress, increasing the risk of depression for the mother and father and perpetuating a cycle that may affect both parents and child.
Behavioral-health professionals, primary-care doctors and community agencies that serve adults with depression often do not consider the impact of parental depression on young children or focus on the adult's role as a parent. For this reason, the new guidelines are significant in recognizing the link between parental depression and child development.
Screening is only a first step in getting mothers and families into needed treatment, however. For screening to be effective, it is important for providers to:
- Develop screening measures for depression and protocols appropriate for the primary-care setting and the staff conducting the screening.
- Turn a protocol into routine practice for referring patients who have been identified as needing treatment.
- Provide training and ongoing support for staff on how to screen and refer patients to services and supports.
Looking beyond primary care to screening outside the health-care system could help even more mothers and children get treatment. Pediatric offices, preschools, early-intervention programs and early-childhood education programs such as Head Start could provide an entry point for working with families at risk for or suffering from parental depression.
Coordinating across systems is key. The Helping Families Raise Healthy Children program — implemented from 2009 to 2013 under the auspices of the Allegheny County Maternal and Child Health Care Collaborative, part of a broad-based coalition across Pennsylvania — attempted to do this by improving the ability of existing county early-intervention and behavioral-health systems to identify families facing the dual challenges of early childhood developmental delays and parental depression. The program then tried to get them into treatment.
My RAND colleagues and I evaluated this program and found that it succeeded on several fronts. It improved care for families at risk for parental depression and early-childhood developmental delays; achieved high rates of screening, referral and engagement in services through collaboration among providers and early-intervention and behavioral-health agencies; and helped build capacity for sustaining these improvements through cross-system training and support for the initiative.
Screening for depression is a critical first step, but more is needed. A well-integrated referral process needs to be in place so that those identified as needing treatment have a clearly identified pathway to obtain the care they need. Efforts like Helping Families Raise Healthy Children hold promise for ameliorating depression among mothers and developmental problems for their young children — the ultimate aim of the new guidelines.
Dana Schultz is a senior policy analyst at the nonprofit, nonpartisan RAND Corporation.
This commentary originally appeared on Pittsburgh Post-Gazette on March 18, 2016.