Maternal Depression Screening

The percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child's first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life

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Maternal depression, also known as post-partum depression, is one of the most common perinatal complications; however, the disorder often remains unrecognized, undiagnosed, and untreated (VanLandeghem, 2006). Studies suggest that over 10 percent of mothers experience depression six weeks after giving birth, whether it is minor or major. Three to 25 percent of women experience major depression during the year following childbirth (Gaynes BN, 2005; Kessler RC, 1994). The incidence of depression may be higher in women who already have young children (VanLandeghem, 2006; Gaynes BN, 2005). Maternal depression can greatly affect mothers, their baby, and their family's well-being. It can have lasting effects on a mother's self-esteem and confidence as a mother (Epperson, 1999). 

Screening is important, as mothers with post-partum depression who are not treated can have symptoms that carry over into the second year post-partum. Mothers that have had post-partum depression are also more likely to have a recurrence with subsequent children. (Epperson, 1999). There are effective treatments available, but less than half of post-partum depression cases are ever diagnosed (Gibson, 2010). Less than 50 percent of mothers with an infant child are currently being screened for post-partum depression (Gjerdingen, Crow, McGovern, Miner, Center, 2009). This measure encourages clinicians to screen new mothers for depression.

U.S. Preventive Services Task Force (USPSTF) (2016)
The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.
Grade: B Recommendation

Bright Futures (2008)
Health care professionals should screen mothers on the following topics:

Mothers of one week old infants:   
Discuss health and depression, family stress, uninvited advice, parent role.  
Differentiate between short-term "baby blues" and postpartum depression, and counsel and refer as appropriate:
It may be helpful to advise women that the "postpartum blues" are a different entity from depression. The "blues," with characteristic tearfulness, anxiety and low mood, are relatively common but are transient, peaking at 3-5 days after birth and resolving by 10-14 days.

Mothers of one month old infants:
Discuss maternal health (postpartum, checkup, depression, substance abuse)

Mothers of two month old children:
Discuss maternal health (maternal postpartum, checkup and resumption of activities, depression)
Grade: Expert Consensus

References
Siu AL and the US Preventive Services Task Force. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016; 315(4): 380-387. 

Hagan, JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove, IL: American Academy of Pediatrics

Higher score indicates better quality

Epperson, C Neill, MD.  Postpartum Major Depression: Detection and Treatment. American Family Physician. April 15, 1999.

Gaynes BN, G. et al. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Summary, Evidence Report/Technology Assessment No. 119. (Prepared by the RTI-University of North Carolina Evidence based Practice Center under Contract No. 290-02-0016.) AHRQ Publication No. 05-E006-1. Rockville, MD: Agency for Healthcare Research and Quality. February 2005.

Gibson J. Screening for Postpartum Depression Not Worth the Time or Money. March 27, 2010.

Gjerdingen D, Crow S, McGovern P, Miner M, Center B. Postpartum Depression Screening at Well-Child Visits: Validity of a 2-Question Screen and the PHQ-9. Annals of Family Medicine 7:63-70 (2009).

Hagan, JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove, IL: American Academy of Pediatrics.

Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8-19.

VanLandeghem K.  National Academy for State Health Policy.  Financing Strategies for Medicaid Reimbursement of Maternal Depression Screening by Pediatric Providers.  April 2006.

Siu AL and the US Preventive Services Task Force. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016; 315(4): 380-387. 

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The eMeasure specifies only patient's (baby) chart, looking for the newly allocated SNOMED codes that allow providers to record the screening and treatment of the mother, but the endorsed measure relies on notes from the patient's and mother's charts

TBD

Children with a visit who turned 6 months of age in the measurement period

Equals Initial Population

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Children with documentation of maternal screening or treatment for postpartum depression for the mother

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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